Provider Demographics
NPI:1205647393
Name:KURTZ, MIKAYLA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:KURTZ
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 1:930 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2647
Mailing Address - Country:US
Mailing Address - Phone:413-523-3456
Mailing Address - Fax:
Practice Address - Street 1:128 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1556
Practice Address - Country:US
Practice Address - Phone:413-523-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1-25-78830103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst