Provider Demographics
NPI:1265283592
Name:INDIVIDUAL PIECE ABA
Entity type:Organization
Organization Name:INDIVIDUAL PIECE ABA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:219-616-4612
Mailing Address - Street 1:99 E 86TH AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6267
Mailing Address - Country:US
Mailing Address - Phone:219-472-8465
Mailing Address - Fax:
Practice Address - Street 1:99 E 86TH AVE STE F
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6267
Practice Address - Country:US
Practice Address - Phone:219-472-8465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty