Provider Demographics
NPI:1861944373
Name:RICHARDSON, KIRA LESLIE (BS, MED, BCBA)
Entity type:Individual
Prefix:MISS
First Name:KIRA
Middle Name:LESLIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:BS, MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11432 209TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1008
Mailing Address - Country:US
Mailing Address - Phone:301-367-6171
Mailing Address - Fax:
Practice Address - Street 1:12485 SW 137TH AVE
Practice Address - Street 2:301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4216
Practice Address - Country:US
Practice Address - Phone:301-367-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-16-23130103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst