Provider Demographics
NPI:1447536149
Name:KEHLER, CARLY (BCBA)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:KEHLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:WAGONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 W MOORE ST
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2144
Mailing Address - Country:US
Mailing Address - Phone:908-229-7693
Mailing Address - Fax:908-864-0090
Practice Address - Street 1:514 W MOORE ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2144
Practice Address - Country:US
Practice Address - Phone:908-229-7693
Practice Address - Fax:908-864-0090
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty