Healthcare Provider Details

I. General information

NPI: 1861828311
Provider Name (Legal Business Name): KERRY ANN KAVANAUGH MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KERI A KAVANAUGH

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 SE 23RD AVE
HOMESTEAD FL
33035-1911
US

IV. Provider business mailing address

2308 SE 23RD AVE
HOMESTEAD FL
33035-1911
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76913
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-16355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: