MEDICARE: KRISTIN DINOVI BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-02-0868

General Provider Information

NPI Number	:	1235465642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN DINOVI BCBA

Provider Business Mailing Address
First Line	:	PO BOX 358
Second Line	:
City	:	MOUNT ROYAL
State	:	NJ
Zip	:	08061-0358
Country	:	US
Telephone Number	:	856-397-6994
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 WINDSOR WAY
Second Line	:
City	:	MOUNT ROYAL
State	:	NJ
Zip	:	08061-1108
Country	:	US
Telephone Number	:	856-397-6994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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