Provider Demographics
NPI:1043686199
Name:HARRIS, KRISTIN NICOLE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:HARRIS
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 1:1415 5TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-2133
Mailing Address - Country:US
Mailing Address - Phone:301-758-2817
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:1415 5TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-2133
Practice Address - Country:US
Practice Address - Phone:301-758-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-42026103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst