Provider Demographics
NPI:1639874704
Name:FORMENTO, KYLEE ANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:ANNE
Last Name:FORMENTO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:ANNE
Other - Last Name:MERENDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 BANKS AVE
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-2508
Mailing Address - Country:US
Mailing Address - Phone:888-726-4774
Mailing Address - Fax:570-362-5112
Practice Address - Street 1:1991 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3173
Practice Address - Country:US
Practice Address - Phone:888-726-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst