Provider Demographics
NPI:1417348400
Name:THOMAS, KHADINE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KHADINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6201
Mailing Address - Country:US
Mailing Address - Phone:347-339-4193
Mailing Address - Fax:
Practice Address - Street 1:15 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6201
Practice Address - Country:US
Practice Address - Phone:347-339-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst