Provider Demographics
NPI:1427941079
Name:WARNING, KELLIE ALYSE (LBA)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:ALYSE
Last Name:WARNING
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1791
Mailing Address - Country:US
Mailing Address - Phone:845-327-7111
Mailing Address - Fax:845-875-9420
Practice Address - Street 1:1301 ROUTE 9
Practice Address - Street 2:
Practice Address - City:TIVOLI
Practice Address - State:NY
Practice Address - Zip Code:12583-5213
Practice Address - Country:US
Practice Address - Phone:914-552-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003625-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst