Provider Demographics
NPI:1861850125
Name:COLE, KILEY LYNN (MS ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:LYNN
Last Name:COLE
Suffix:
Gender:F
Credentials:MS ED, BCBA, LBA
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 828
Mailing Address - Street 2:
Mailing Address - City:VERPLANCK
Mailing Address - State:NY
Mailing Address - Zip Code:10596
Mailing Address - Country:US
Mailing Address - Phone:914-874-7662
Mailing Address - Fax:
Practice Address - Street 1:277 9TH STREET
Practice Address - Street 2:APT 1
Practice Address - City:VERPLANCK
Practice Address - State:NY
Practice Address - Zip Code:10596
Practice Address - Country:US
Practice Address - Phone:914-874-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001244-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst