Healthcare Provider Details

I. General information

NPI: 1396698932
Provider Name (Legal Business Name): KRISTINA MARCELLA HINES BCBA, QBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 61ST ST FL 3013
BROOKLYN NY
11204-2746
US

IV. Provider business mailing address

10279 MORNING MIST LN
SARASOTA FL
34241-1512
US

V. Phone/Fax

Practice location:
  • Phone: 212-481-4040
  • Fax: 212-414-4660
Mailing address:
  • Phone: 212-481-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-83140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: