=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508095704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN NANCY FOLEY BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2009
-----------------------------------------------------
Last Update Date | 02/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 FIERRO AVE
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-3038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-788-5850
-----------------------------------------------------
Fax | 708-801-7211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 FIERRO AVE
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-3038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-788-5850
-----------------------------------------------------
Fax | 708-801-7211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-08-4076
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------