Provider Demographics
NPI:1144888785
Name:JAMES, KELLY ANN (MS, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MANNING ST APT 11A
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1032
Mailing Address - Country:US
Mailing Address - Phone:774-218-6232
Mailing Address - Fax:
Practice Address - Street 1:200 MANNING ST APT 11A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1032
Practice Address - Country:US
Practice Address - Phone:774-218-6232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2606-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2606-MH-B1OtherCOMMONWEALTH OF MASSACHUSETTS
1-18-34166OtherBEHAVIOR ANALYST CERTIFICATION BOARD