Provider Demographics
NPI:1427768365
Name:BAZILE, KARLENE ALLISON (ABA BEHAVIOR TECH)
Entity type:Individual
Prefix:MRS
First Name:KARLENE
Middle Name:ALLISON
Last Name:BAZILE
Suffix:
Gender:F
Credentials:ABA BEHAVIOR TECH
Other - Prefix:MRS
Other - First Name:KARLENE
Other - Middle Name:ALLISON
Other - Last Name:WILSON-BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ABA
Mailing Address - Street 1:350 FAIRWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1834
Mailing Address - Country:US
Mailing Address - Phone:877-418-2978
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:4201 N I 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6713
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician