Provider Demographics
NPI:1346508132
Name:KINNEY, KATHRYN (LCSW, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W EAU GALLIE BLVD
Mailing Address - Street 2:STE 96
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5390
Mailing Address - Country:US
Mailing Address - Phone:321-272-8336
Mailing Address - Fax:
Practice Address - Street 1:1301 W EAU GALLIE BLVD
Practice Address - Street 2:STE 96
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5390
Practice Address - Country:US
Practice Address - Phone:321-272-8336
Practice Address - Fax:321-421-6993
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1119521103K00000X
FLSW98971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst