Provider Demographics
NPI:1356086243
Name:VALE, KISHA (BCBA)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:VALE
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 1:118 BEMIS RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-6483
Mailing Address - Country:US
Mailing Address - Phone:978-259-8691
Mailing Address - Fax:
Practice Address - Street 1:118 BEMIS RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-6483
Practice Address - Country:US
Practice Address - Phone:978-259-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty