Provider Demographics
NPI:1316645617
Name:CLAYTON, KATHLEEN (RBT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 SERPENTINE DR
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-3238
Mailing Address - Country:US
Mailing Address - Phone:862-205-1603
Mailing Address - Fax:
Practice Address - Street 1:1839 SERPENTINE DR
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-3238
Practice Address - Country:US
Practice Address - Phone:862-205-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19-100455106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician