Provider Demographics
NPI:1295548196
Name:PEDIATRIC ABA AND AUTISM SUPPORTS OF NORTHERN KENTUCKY LLC
Entity type:Organization
Organization Name:PEDIATRIC ABA AND AUTISM SUPPORTS OF NORTHERN KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:859-443-6622
Mailing Address - Street 1:42 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1860
Mailing Address - Country:US
Mailing Address - Phone:859-443-6622
Mailing Address - Fax:
Practice Address - Street 1:42 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1860
Practice Address - Country:US
Practice Address - Phone:859-443-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty