Healthcare Provider Details

I. General information

NPI: 1871043554
Provider Name (Legal Business Name): KELLY FITZGERALD BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY BARKER

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 STRATFORD RD
CANTON MA
02021-4213
US

IV. Provider business mailing address

5 STRATFORD RD
CANTON MA
02021-4213
US

V. Phone/Fax

Practice location:
  • Phone: 781-366-4210
  • Fax:
Mailing address:
  • Phone: 781-366-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2861
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: