Healthcare Provider Details

I. General information

NPI: 1659080406
Provider Name (Legal Business Name): KRISTEN NICOLE KOBYLARZ BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 ARGENT BLVD STE 104
RIDGELAND SC
29936-3268
US

IV. Provider business mailing address

3319 ARGENT BLVD STE 104
RIDGELAND SC
29936-3268
US

V. Phone/Fax

Practice location:
  • Phone: 978-224-8753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17250
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: