Basic Information
| Provider Information | |||||||||
| NPI: | 1033557004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOERGEL | ||||||||
| FirstName: | CARMEL JANE | ||||||||
| MiddleName: | ARCUNA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8278 VERNON ST | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201094414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038535925 | ||||||||
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| Practice Location | |||||||||
| Address1: | 373 WILLOW ST, SUITE 266 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773158080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2013 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0133000270 | VA | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.