Provider Demographics
NPI:1033877659
Name:DEVEREAUX, KAITLYN (BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1320
Mailing Address - Country:US
Mailing Address - Phone:856-383-0226
Mailing Address - Fax:
Practice Address - Street 1:6122 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1603
Practice Address - Country:US
Practice Address - Phone:215-487-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABACB292436103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst