Provider Demographics
NPI:1538638416
Name:KANAKIS, NOMIKI (BCBA-LBA)
Entity Type:Individual
Prefix:MRS
First Name:NOMIKI
Middle Name:
Last Name:KANAKIS
Suffix:
Gender:F
Credentials:BCBA-LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3746
Mailing Address - Country:US
Mailing Address - Phone:203-234-1258
Mailing Address - Fax:
Practice Address - Street 1:171 ROCK RD
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3746
Practice Address - Country:US
Practice Address - Phone:203-234-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-17-25438103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst