Provider Demographics
NPI:1689146805
Name:NOBER, KELLY A (BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:NOBER
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 1:391 WAHL RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:12758-7042
Mailing Address - Country:US
Mailing Address - Phone:518-669-0916
Mailing Address - Fax:
Practice Address - Street 1:391 WAHL RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON MANOR
Practice Address - State:NY
Practice Address - Zip Code:12758-7042
Practice Address - Country:US
Practice Address - Phone:518-669-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst