Provider Demographics
NPI:1497019244
Name:SOTO-VAUGHAN, KRISTYNNA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KRISTYNNA
Middle Name:
Last Name:SOTO-VAUGHAN
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SUBURBIA DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1252
Mailing Address - Country:US
Mailing Address - Phone:718-637-7592
Mailing Address - Fax:
Practice Address - Street 1:39 SUBURBIA DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1252
Practice Address - Country:US
Practice Address - Phone:718-637-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002740103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst