Provider Demographics
NPI:1104301712
Name:SPAETHLING, KIMBERLY ANN (MED BCBA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:SPAETHLING
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:ANN
Other - Last Name:S-CECCARELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED BCBA
Mailing Address - Street 1:461 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4349
Mailing Address - Country:US
Mailing Address - Phone:978-866-1086
Mailing Address - Fax:
Practice Address - Street 1:461 RIVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4349
Practice Address - Country:US
Practice Address - Phone:978-866-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst