Provider Demographics
NPI:1154705861
Name:STEVENSON-POSTLE, KELLY (BCBA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STEVENSON-POSTLE
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 1:26 BURR OAK DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3541
Mailing Address - Country:US
Mailing Address - Phone:716-228-4619
Mailing Address - Fax:
Practice Address - Street 1:26 BURR OAK DR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3541
Practice Address - Country:US
Practice Address - Phone:716-228-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000377103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst