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General NPI Number Information
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NPI Number | 1730721515
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Entity Type | Individual
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Provider Name | KELLY MARIE KUYLEN BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2019
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Last Update Date | 10/12/2019
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Provider Practice Location Address
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Address Line | 229 LAUREL RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-1118
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Country | US
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Telephone | 305-788-9744
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Fax |
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Provider Business Mailing Address
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Address Line | 169 WANSER AVE
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City | INWOOD
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State | NY
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Zip | 11096-2114
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Country | US
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Telephone | 305-788-9744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0014661
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License Number State | NY
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