Provider Demographics
NPI:1073109716
Name:KANE, COURTNEY LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:KANE
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 1:21 N BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1029
Mailing Address - Country:US
Mailing Address - Phone:973-981-0769
Mailing Address - Fax:
Practice Address - Street 1:21 N BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1029
Practice Address - Country:US
Practice Address - Phone:973-981-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst