Provider Demographics
NPI:1811592132
Name:MOLONEY, KEVIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MOLONEY
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:PO BOX 25627
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824-1627
Mailing Address - Country:US
Mailing Address - Phone:781-820-9489
Mailing Address - Fax:
Practice Address - Street 1:79 ESTATE PETERS REST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-0082
Practice Address - Country:US
Practice Address - Phone:781-820-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
12044062OtherBACB IDENTIFICATION NUMBER