Provider Demographics
NPI:1154117976
Name:CARLISLE, ELAINA NEVAEH
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:NEVAEH
Last Name:CARLISLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6141
Mailing Address - Country:US
Mailing Address - Phone:402-812-8286
Mailing Address - Fax:
Practice Address - Street 1:1649 61ST STREET
Practice Address - Street 2:ST 301 3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3319
Practice Address - Country:US
Practice Address - Phone:718-633-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty