Provider Demographics
NPI:1275085946
Name:BARKER, KELLIE (M ED, BCBA)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:M ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SPINDLEWICK DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-4515
Mailing Address - Country:US
Mailing Address - Phone:978-781-6837
Mailing Address - Fax:978-710-6941
Practice Address - Street 1:51 SPINDLEWICK DR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-4515
Practice Address - Country:US
Practice Address - Phone:978-781-6837
Practice Address - Fax:978-710-6941
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-16-23144103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst