Provider Demographics
NPI:1164938403
Name:SCHAEFER, KRYSTA (BCBA, MS, LBA)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:BCBA, MS, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12541 W STATE CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-1940
Mailing Address - Country:US
Mailing Address - Phone:203-247-5023
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR UNIT B106
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6339
Practice Address - Country:US
Practice Address - Phone:203-247-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-17-41612106S00000X
AZBCBA-1-18-32469103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician