Healthcare Provider Details

I. General information

NPI: 1366365058
Provider Name (Legal Business Name): SYDNEY KROUTCH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S WILMINGTON ST
RALEIGH NC
27601-1847
US

IV. Provider business mailing address

258 WARBLER WAY
HAMPSTEAD NC
28443-8518
US

V. Phone/Fax

Practice location:
  • Phone: 717-892-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2832649
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: