Provider Demographics
NPI:1427883685
Name:CALLARI, LACIE J (MA BCBA)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:J
Last Name:CALLARI
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CAMBRA RD
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1103
Mailing Address - Country:US
Mailing Address - Phone:973-650-8040
Mailing Address - Fax:
Practice Address - Street 1:23 CAMBRA RD
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1103
Practice Address - Country:US
Practice Address - Phone:973-650-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst