Provider Demographics
NPI:1356735070
Name:VAN HORN, KEVIN (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:VAN HORN
Suffix:
Gender:M
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 1:1722 COMMONWEALTH AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5621
Mailing Address - Country:US
Mailing Address - Phone:551-497-0438
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST
Practice Address - Street 2:SUITE G-10
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:551-497-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst