Provider Demographics
NPI:1871043554
Name:BARKER, KELLY (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OAK ST STE G20
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1492
Mailing Address - Country:US
Mailing Address - Phone:617-658-5611
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST STE G20
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-658-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst