Provider Demographics
NPI:1407267297
Name:MAKOUS, KRISTEN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MAKOUS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:
Other - Last Name:MAKOUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:83 KING GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:SPACKENKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2919
Mailing Address - Country:US
Mailing Address - Phone:917-685-5908
Mailing Address - Fax:
Practice Address - Street 1:6400 ARLINGTON BLVD STE 670
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2336
Practice Address - Country:US
Practice Address - Phone:703-992-6938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-14571103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst