Provider Demographics
NPI:1790163988
Name:BRINTNELL, KEVIN A (BCBA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:BRINTNELL
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 1:11258 COIMBRA LN
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-5368
Mailing Address - Country:US
Mailing Address - Phone:239-249-1840
Mailing Address - Fax:239-236-1221
Practice Address - Street 1:11258 COIMBRA LN
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5368
Practice Address - Country:US
Practice Address - Phone:239-249-1840
Practice Address - Fax:239-236-1221
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-18280103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst