Provider Demographics
NPI:1376236380
Name:NATHAN, KRISTA MARIE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:NATHAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:MARIE
Other - Last Name:FLECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:315 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8103
Mailing Address - Country:US
Mailing Address - Phone:914-406-0034
Mailing Address - Fax:
Practice Address - Street 1:315 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-8103
Practice Address - Country:US
Practice Address - Phone:914-406-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-21-51734103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst