Provider Demographics
NPI:1245712561
Name:ADAMS, KELLY ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 BUCK HL
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-4812
Mailing Address - Country:US
Mailing Address - Phone:570-390-0206
Mailing Address - Fax:
Practice Address - Street 1:145 BUCK HL
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4812
Practice Address - Country:US
Practice Address - Phone:570-390-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11624065103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst