Provider Demographics
NPI:1124335039
Name:DINTINO, KATELYN M (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:M
Last Name:DINTINO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:M
Other - Last Name:FABBRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 ALLENS LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2004
Mailing Address - Country:US
Mailing Address - Phone:856-417-3094
Mailing Address - Fax:
Practice Address - Street 1:220 ALLENS LN
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2004
Practice Address - Country:US
Practice Address - Phone:856-417-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-10-6814103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst