Provider Demographics
NPI:1447643929
Name:SCHLICHENMEYER, KEVIN (BCBA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SCHLICHENMEYER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-6224
Mailing Address - Country:US
Mailing Address - Phone:608-397-6528
Mailing Address - Fax:
Practice Address - Street 1:676 GREAT RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-6224
Practice Address - Country:US
Practice Address - Phone:608-397-6528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-122-12292103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst