Provider Demographics
NPI:1700567369
Name:WINER, KAELA (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:WINER
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 VILLAGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1963
Mailing Address - Country:US
Mailing Address - Phone:561-335-5681
Mailing Address - Fax:
Practice Address - Street 1:8 ESSEX DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2959
Practice Address - Country:US
Practice Address - Phone:877-394-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA5000834103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst