Provider Demographics
NPI:1699596353
Name:GOODWIN, KAYLEE (BCBA)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:GOODWIN
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 1:144 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2886
Mailing Address - Country:US
Mailing Address - Phone:603-459-2795
Mailing Address - Fax:603-459-2783
Practice Address - Street 1:144 CANAL ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2886
Practice Address - Country:US
Practice Address - Phone:603-882-6333
Practice Address - Fax:603-459-2783
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-24-76113103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst