Provider Demographics
NPI:1497081491
Name:PRIETO, KELLY J (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:J
Last Name:PRIETO
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4325
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-4325
Mailing Address - Country:US
Mailing Address - Phone:844-422-2435
Mailing Address - Fax:562-219-7458
Practice Address - Street 1:19117 ALPHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7215
Practice Address - Country:US
Practice Address - Phone:844-422-2435
Practice Address - Fax:562-219-7458
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-08-4472103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst