Provider Demographics
NPI:1447026430
Name:ROBINSON, CARLISA (BCBA)
Entity type:Individual
Prefix:
First Name:CARLISA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 S J ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-2955
Mailing Address - Country:US
Mailing Address - Phone:317-918-2689
Mailing Address - Fax:317-973-0196
Practice Address - Street 1:2032 S J ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2955
Practice Address - Country:US
Practice Address - Phone:317-918-2689
Practice Address - Fax:317-973-0196
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-23-68714103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst