Provider Demographics
NPI:1184210205
Name:MARTONI, KELLY ANN (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:MARTONI
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 1:103 ARTILLERY RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2304
Mailing Address - Country:US
Mailing Address - Phone:475-313-5688
Mailing Address - Fax:
Practice Address - Street 1:103 ARTILLERY RD # TD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2304
Practice Address - Country:US
Practice Address - Phone:475-313-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001083103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst