Provider Demographics
NPI:1316241599
Name:MACNEIL, KRISTEN (MA/CAS, BCBA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MACNEIL
Suffix:
Gender:F
Credentials:MA/CAS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5145
Mailing Address - Country:US
Mailing Address - Phone:716-207-9029
Mailing Address - Fax:
Practice Address - Street 1:1200 EAST AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:716-828-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst