Provider Demographics
NPI:1265978845
Name:TUFFY, KATHRYN (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:TUFFY
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ONTARIO RD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4161
Mailing Address - Country:US
Mailing Address - Phone:516-521-8738
Mailing Address - Fax:
Practice Address - Street 1:64 ONTARIO RD
Practice Address - Street 2:
Practice Address - City:BELLEROSE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11001-4161
Practice Address - Country:US
Practice Address - Phone:516-521-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-5767103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst