Individual
MRS. CARLY PIACENTINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
9616 PORTAGE RD, PORTAGE, MI 49002-7257
(269) 929-3850
Mailing address
9616 PORTAGE RD, PORTAGE, MI 49002-7257
(269) 929-3850
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-12-10212
MI
Other
Enumeration date
06/19/2012
Last updated
09/17/2012
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