Provider Demographics
NPI:1659514180
Name:PERKINS, KRISTY LEE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LEE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 TARR AVE SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7403
Mailing Address - Country:US
Mailing Address - Phone:321-848-5331
Mailing Address - Fax:
Practice Address - Street 1:598 TARR AVE SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7403
Practice Address - Country:US
Practice Address - Phone:321-848-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-20762103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst