Provider Demographics
NPI:1215253810
Name:KENNEALLY, LAURA A (EDD, BCBA)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:KENNEALLY
Suffix:
Gender:F
Credentials:EDD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 GLASSBORO RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8721
Mailing Address - Country:US
Mailing Address - Phone:856-881-0400
Mailing Address - Fax:856-374-4060
Practice Address - Street 1:1880 GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-8721
Practice Address - Country:US
Practice Address - Phone:856-881-0400
Practice Address - Fax:856-374-4060
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-07-3201103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst