Provider Demographics
NPI:1457702250
Name:STIFFEL, KIELIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KIELIN
Middle Name:
Last Name:STIFFEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KIELIN
Other - Middle Name:
Other - Last Name:GREELEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:158 RIVEREDGE RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1925
Mailing Address - Country:US
Mailing Address - Phone:201-655-4887
Mailing Address - Fax:
Practice Address - Street 1:158 RIVEREDGE RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1925
Practice Address - Country:US
Practice Address - Phone:201-655-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-14913103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst