Provider Demographics
NPI:1679871628
Name:MESKOWSKY, KURT MARSHALL (BCBA)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:MARSHALL
Last Name:MESKOWSKY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 REGENT CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3222
Mailing Address - Country:US
Mailing Address - Phone:916-316-7333
Mailing Address - Fax:
Practice Address - Street 1:1465 REGENT CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-3222
Practice Address - Country:US
Practice Address - Phone:916-316-7333
Practice Address - Fax:916-543-7909
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01-06-3197103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst