Provider Demographics
NPI:1295063147
Name:KHOMUTETSKY, HYNDI E (BCBA)
Entity type:Individual
Prefix:MS
First Name:HYNDI
Middle Name:E
Last Name:KHOMUTETSKY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 W SR 434 STE 108
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4953
Mailing Address - Country:US
Mailing Address - Phone:407-324-7772
Mailing Address - Fax:321-248-0717
Practice Address - Street 1:1060 W SR 434 STE 108
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4953
Practice Address - Country:US
Practice Address - Phone:407-324-7772
Practice Address - Fax:321-248-0717
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst