Provider Demographics
NPI:1508302126
Name:KITTREDGE, AMY (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KITTREDGE
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 1:17 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03052-1041
Mailing Address - Country:US
Mailing Address - Phone:603-305-5650
Mailing Address - Fax:
Practice Address - Street 1:23 WEST ST
Practice Address - Street 2:UNIT #3
Practice Address - City:ASHLAND
Practice Address - State:NH
Practice Address - Zip Code:03217-4219
Practice Address - Country:US
Practice Address - Phone:603-305-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-16-23800103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst