Provider Demographics
NPI:1336687904
Name:PRUKALSKI, KATE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:
Last Name:PRUKALSKI
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 1:20 ALLISON LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-2607
Mailing Address - Country:US
Mailing Address - Phone:845-428-1229
Mailing Address - Fax:
Practice Address - Street 1:210 BELLEFONTE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2502
Practice Address - Country:US
Practice Address - Phone:302-762-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-16-24645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1-16-24645OtherBEHAVIOR ANALYST CERTIFICATION BOARD