MEDICARE: KUDOS AUTISM THERAPY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	106E00000X	Assistant Behavior Analyst
3	106S00000X	Behavior Technician
4	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1285591776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUDOS AUTISM THERAPY, LLC

Provider Business Mailing Address
First Line	:	168 JONES FISH CAMP RD
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32141-7210
Country	:	US
Telephone Number	:	580-308-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	168 JONES FISH CAMP RD
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32141-7210
Country	:	US
Telephone Number	:	580-308-4747
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ERICA KINNEBREW
Credential	:
Telephone Number	:	580-308-4747

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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