Healthcare Provider Details

I. General information

NPI: 1619857760
Provider Name (Legal Business Name): KRYSTINA MARIE HEYWOOD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GRIFFIN RD
PORTSMOUTH NH
03801-7145
US

IV. Provider business mailing address

233 S MAIN ST
SEABROOK NH
03874-4619
US

V. Phone/Fax

Practice location:
  • Phone: 800-778-5560
  • Fax:
Mailing address:
  • Phone: 603-918-9150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: