Provider Demographics
NPI:1386410512
Name:SPOONER, KRISTOPHER (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:SPOONER
Suffix:
Gender:M
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2752
Mailing Address - Country:US
Mailing Address - Phone:508-807-4996
Mailing Address - Fax:
Practice Address - Street 1:792 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2752
Practice Address - Country:US
Practice Address - Phone:508-807-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10000520103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst