Provider Demographics
NPI:1891332003
Name:DICOSTANZO, KATHY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:DICOSTANZO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CHESTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2556
Mailing Address - Country:US
Mailing Address - Phone:845-248-5450
Mailing Address - Fax:
Practice Address - Street 1:1115 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3641
Practice Address - Country:US
Practice Address - Phone:973-210-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11936296103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty