Provider Demographics
NPI:1992198584
Name:KELLY, KIM MARIE (BCBA)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:KELLY
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 1:20 TATER ST
Mailing Address - Street 2:
Mailing Address - City:MONT VERNON
Mailing Address - State:NH
Mailing Address - Zip Code:03057-1315
Mailing Address - Country:US
Mailing Address - Phone:603-673-7015
Mailing Address - Fax:603-673-8052
Practice Address - Street 1:20 TATER ST
Practice Address - Street 2:
Practice Address - City:MONT VERNON
Practice Address - State:NH
Practice Address - Zip Code:03057-1315
Practice Address - Country:US
Practice Address - Phone:603-673-7015
Practice Address - Fax:603-673-8052
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst