Provider Demographics
NPI:1891925400
Name:THOMSEN, KRISTEN ANN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANN
Last Name:THOMSEN
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 1:4 WHITNEY PL
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-6251
Mailing Address - Country:US
Mailing Address - Phone:856-220-9903
Mailing Address - Fax:
Practice Address - Street 1:466 DORCHESTER DR
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1372
Practice Address - Country:US
Practice Address - Phone:856-220-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-08-2583103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJKRISASN777OtherTRICARE