Provider Demographics
NPI:1912415316
Name:MARRA, KAILA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:MARRA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GOLDBLATT TER
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1416
Mailing Address - Country:US
Mailing Address - Phone:973-885-8750
Mailing Address - Fax:
Practice Address - Street 1:12 GOLDBLATT TER
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1416
Practice Address - Country:US
Practice Address - Phone:973-885-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-26971103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst