Provider Demographics
NPI:1275835183
Name:MCCLOSKEY, KRISTEN (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 STORIG AVE
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1118
Mailing Address - Country:US
Mailing Address - Phone:551-404-3460
Mailing Address - Fax:
Practice Address - Street 1:35 STORIG AVE
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1118
Practice Address - Country:US
Practice Address - Phone:551-404-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-10-7666103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst