Provider Demographics
NPI:1780379925
Name:MORAN, KATHLEEN (BCBA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MELLO PKWY
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2627
Mailing Address - Country:US
Mailing Address - Phone:617-759-9645
Mailing Address - Fax:
Practice Address - Street 1:9 MELLO PKWY
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2627
Practice Address - Country:US
Practice Address - Phone:617-759-9645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3280-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst