Provider Demographics
NPI:1992137905
Name:METZ, KASSI LYNN (MS ED, BCBA)
Entity type:Individual
Prefix:MS
First Name:KASSI
Middle Name:LYNN
Last Name:METZ
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MANALAPAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1658
Mailing Address - Country:US
Mailing Address - Phone:732-322-9985
Mailing Address - Fax:
Practice Address - Street 1:23 MANALAPAN RD
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1658
Practice Address - Country:US
Practice Address - Phone:732-322-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ1-16-22653103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist