Individual
KARLIE MICHELLE FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
716 WILLIS PL, ROSELLE PARK, NJ 07204-1227
(601) 882-4690
Mailing address
716 WILLIS PL, ROSELLE PARK, NJ 07204-1227
(601) 882-4690
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-27164
MS
Other
Enumeration date
02/01/2018
Last updated
08/05/2025
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