Provider Demographics
NPI:1285329441
Name:PROZZO, KATHRYN (BCBA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PROZZO
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 1:114 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3640
Mailing Address - Country:US
Mailing Address - Phone:732-759-4018
Mailing Address - Fax:
Practice Address - Street 1:114 IRIS DR
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3640
Practice Address - Country:US
Practice Address - Phone:732-759-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-58762103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst