Provider Demographics
NPI:1700236171
Name:SUMMERS, KAITLYN ELIZABETH (MSED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MSED, BCBA, LBA
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:ELIZABETH
Other - Last Name:MEAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:2929 OAK CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3422
Mailing Address - Country:US
Mailing Address - Phone:516-314-3764
Mailing Address - Fax:
Practice Address - Street 1:2929 OAK CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3422
Practice Address - Country:US
Practice Address - Phone:516-314-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003339103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst