Provider Demographics
NPI:1639478910
Name:KAMINSKI, MARY BAIRD (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BAIRD
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1515
Mailing Address - Country:US
Mailing Address - Phone:781-413-4628
Mailing Address - Fax:
Practice Address - Street 1:461 RIVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4213
Practice Address - Country:US
Practice Address - Phone:978-654-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-05-2289103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst