Provider Demographics
NPI:1962988808
Name:O'HEARN, KATELYN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:O'HEARN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:388 HICKORY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 AMBUSH ST APT 310
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5679
Practice Address - Country:US
Practice Address - Phone:631-901-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-23-66138103K00000X
NCRBT-21-183995106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst