Provider Demographics
NPI:1528376704
Name:NEPO, KAORI GUNJI (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KAORI
Middle Name:GUNJI
Last Name:NEPO
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 1:503 S OLD MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4909
Mailing Address - Country:US
Mailing Address - Phone:610-316-8564
Mailing Address - Fax:
Practice Address - Street 1:503 S OLD MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-4909
Practice Address - Country:US
Practice Address - Phone:610-316-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1052374103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst