Provider Demographics
NPI:1396087706
Name:DENIGER, KATHLEEN (MPA BCBA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DENIGER
Suffix:
Gender:F
Credentials:MPA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST BLDG 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1222
Mailing Address - Country:US
Mailing Address - Phone:508-808-0323
Mailing Address - Fax:413-224-2274
Practice Address - Street 1:34 RITTER ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3736
Practice Address - Country:US
Practice Address - Phone:508-808-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-12627103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst