Provider Demographics
NPI:1912207366
Name:ST. CLAIR, KELLEY EMMA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:EMMA
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 E RED BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2287
Mailing Address - Country:US
Mailing Address - Phone:413-322-9096
Mailing Address - Fax:
Practice Address - Street 1:27 E RED BRIDGE LN
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2287
Practice Address - Country:US
Practice Address - Phone:413-374-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-12610103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst