Provider Demographics
NPI:1619268687
Name:STOREY, KRISTEN NICOLE (MS, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:STOREY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 OLD SIMMONSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-6027
Mailing Address - Country:US
Mailing Address - Phone:401-433-8381
Mailing Address - Fax:
Practice Address - Street 1:2348 POST RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2258
Practice Address - Country:US
Practice Address - Phone:401-681-4637
Practice Address - Fax:401-681-4675
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-11-8425103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst