Healthcare Provider Details

I. General information

NPI: 1164938403
Provider Name (Legal Business Name): KRYSTA SCHAEFER BCBA, MS, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR UNIT B106
TRUMBULL CT
06611-6339
US

IV. Provider business mailing address

12541 W STATE CT
GLENDALE AZ
85307-1940
US

V. Phone/Fax

Practice location:
  • Phone: 203-247-5023
  • Fax:
Mailing address:
  • Phone: 203-247-5023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-18-32469
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-41612
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: