Provider Demographics
NPI:1669798914
Name:MCNAMARA, KEVIN M (BCBA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 LYTLE ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1813
Mailing Address - Country:US
Mailing Address - Phone:570-622-6417
Mailing Address - Fax:570-622-3230
Practice Address - Street 1:600 LYTLE ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1813
Practice Address - Country:US
Practice Address - Phone:570-622-6417
Practice Address - Fax:570-622-3230
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-09-6458103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst