Provider Demographics
NPI:1053145078
Name:KARANI, MICHAEL GATOBU
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GATOBU
Last Name:KARANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 VILLAGE VIEW TER
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-5078
Mailing Address - Country:US
Mailing Address - Phone:203-709-1303
Mailing Address - Fax:
Practice Address - Street 1:11 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1636
Practice Address - Country:US
Practice Address - Phone:860-930-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-24-74973103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst