Provider Demographics
NPI:1356741581
Name:KIRCHNER, KRISTEN (MED, BCABA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:MED, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 EAGLE BEND TER
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-9507
Mailing Address - Country:US
Mailing Address - Phone:904-583-3441
Mailing Address - Fax:
Practice Address - Street 1:1825 EAGLE BEND TER
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-9507
Practice Address - Country:US
Practice Address - Phone:904-583-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
FL0-04-1324103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst