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NPI Code Detail

MEDICARE: KYLIE THIBEAULT BCBA

MEDICARE: KYLIE THIBEAULT 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
12355S0801XSpeech-Language Assistant
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1649659160
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLIE THIBEAULT BCBA
Provider Business Mailing Address
First Line : 945 N CENTRAL AVE
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1604
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 945 N CENTRAL AVE STE 201
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1604
Country : US
Telephone Number : 516-703-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2015
Last Update Date : 07/24/2024

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