Provider Demographics
NPI:1366085599
Name:DIMARTINO, KAYLA PATERNOSTRO (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:PATERNOSTRO
Last Name:DIMARTINO
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 1:3999 HIGHWAY 190 EAST SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4914
Mailing Address - Country:US
Mailing Address - Phone:985-871-0689
Mailing Address - Fax:985-871-0690
Practice Address - Street 1:3999 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4914
Practice Address - Country:US
Practice Address - Phone:985-871-0689
Practice Address - Fax:985-871-0690
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
LAL-403103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst