Provider Demographics
NPI:1871912360
Name:BRYSON, KELLY KENNEDY (BCBA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KENNEDY
Last Name:BRYSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 FAIRWAY DR
Mailing Address - Street 2:STE 102
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1814
Mailing Address - Country:US
Mailing Address - Phone:954-603-7885
Mailing Address - Fax:954-342-9273
Practice Address - Street 1:500 FAIRWAY DR
Practice Address - Street 2:STE 102
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1814
Practice Address - Country:US
Practice Address - Phone:954-603-7885
Practice Address - Fax:954-342-9273
Is Sole Proprietor?:No
Enumeration Date:2014-04-11
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst