Active NPI
Caroline Madeline Wallace, MS, BCBA
- Behavior Analyst
- Stonington, CT
National Provider Identifier
1841857141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 805
- Practice address
- 4 Broadway Ave Ext, Unit 3
Stonington, CT 06378 - Phone
- (860) 980-3233
- NPI assigned
- May 22, 2019
- Last updated
- May 22, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 805 | CT | Primary |
Addresses
Primary practice location
4 Broadway Ave Ext, Unit 3
Stonington, CT 06378
Mailing address
5 Wood Crest Dr
Old Lyme, CT 06371-2840
Phone (207) 228-3291
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558483200000",
"number": "1841857141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 WOOD CREST DR",
"city": "OLD LYME",
"state": "CT",
"postal_code": "063712840",
"telephone_number": "207-228-3291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 BROADWAY AVE EXT, UNIT 3",
"city": "STONINGTON",
"state": "CT",
"postal_code": "06378",
"telephone_number": "860-980-3233"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "CAROLINE",
"middle_name": "MADELINE",
"name_prefix": "Mrs.",
"credential": "MS, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-22",
"last_updated": "2019-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CT",
"license": "805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stonington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.