Provider Demographics
NPI:1396046157
Name:SRIKANTH, KAMALATHARA (MA, MAT, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KAMALATHARA
Middle Name:
Last Name:SRIKANTH
Suffix:
Gender:F
Credentials:MA, MAT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VAN GOGH DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2999
Mailing Address - Country:US
Mailing Address - Phone:609-443-8244
Mailing Address - Fax:
Practice Address - Street 1:12 VAN GOGH DR
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2999
Practice Address - Country:US
Practice Address - Phone:609-443-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7089103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst