Provider Demographics
NPI:1497133888
Name:PORTER-MAHONEY, KATLYN (BCBA)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:PORTER-MAHONEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4169
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-4169
Mailing Address - Country:US
Mailing Address - Phone:413-422-1227
Mailing Address - Fax:413-422-1079
Practice Address - Street 1:1 RIVER ST
Practice Address - Street 2:
Practice Address - City:ERVING
Practice Address - State:MA
Practice Address - Zip Code:01344-4403
Practice Address - Country:US
Practice Address - Phone:413-422-1227
Practice Address - Fax:413-422-1079
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst