MEDICARE: MISS KATHRYN ADELE IRVING BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1285395384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHRYN ADELE IRVING BCBA

Provider Business Mailing Address
First Line	:	136 BEEBETOWN RD
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-2339
Country	:	US
Telephone Number	:	856-524-2066
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 SECOND AVE
Second Line	:
City	:	WEST CAPE MAY
State	:	NJ
Zip	:	08204-1045
Country	:	US
Telephone Number	:	201-675-0316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	01/02/2022

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