Provider Demographics
NPI:1831524677
Name:KIRSTEN, ELLE BEN (PHD, MSC, BCBA, LBA)
Entity type:Individual
Prefix:DR
First Name:ELLE
Middle Name:BEN
Last Name:KIRSTEN
Suffix:
Gender:F
Credentials:PHD, MSC, BCBA, LBA
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4615 CENTER BLVD APT 3907
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5779
Mailing Address - Country:US
Mailing Address - Phone:646-647-0942
Mailing Address - Fax:
Practice Address - Street 1:4615 CENTER BLVD APT 3907
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5779
Practice Address - Country:US
Practice Address - Phone:646-647-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1106880103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst