Provider Demographics
NPI:1386218659
Name:SESSELMAN-BROWN, KELSI N (BCBA)
Entity type:Individual
Prefix:MS
First Name:KELSI
Middle Name:N
Last Name:SESSELMAN-BROWN
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 1:238 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:12865-3115
Mailing Address - Country:US
Mailing Address - Phone:802-282-6367
Mailing Address - Fax:
Practice Address - Street 1:238 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NY
Practice Address - Zip Code:12865-3115
Practice Address - Country:US
Practice Address - Phone:802-282-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-19-36653103K00000X
VT146.0134252103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst