Provider Demographics
NPI:1659845121
Name:DONOVAN, KAITLYN (BCBA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:DONOVAN
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 1:180 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5814
Mailing Address - Country:US
Mailing Address - Phone:973-390-0459
Mailing Address - Fax:
Practice Address - Street 1:180 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5814
Practice Address - Country:US
Practice Address - Phone:973-390-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-32829103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst