Provider Demographics
NPI:1124344866
Name:NELSON, STEPHANIE KILLORIN (BCBA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KILLORIN
Last Name:NELSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:KILLORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:21600 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4976
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:818-758-8015
Practice Address - Street 1:331 MONTVALE AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4675
Practice Address - Country:US
Practice Address - Phone:781-281-7601
Practice Address - Fax:781-634-6209
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst