Provider Demographics
NPI:1295516722
Name:KB-ABA
Entity type:Organization
Organization Name:KB-ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:JULIETTE
Authorized Official - Last Name:BACSKOCZKY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-425-0344
Mailing Address - Street 1:11 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1214
Mailing Address - Country:US
Mailing Address - Phone:732-425-0344
Mailing Address - Fax:
Practice Address - Street 1:11 FIRST ST
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1214
Practice Address - Country:US
Practice Address - Phone:732-425-0344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1073123253OtherNPEES