Provider Demographics
NPI:1992264584
Name:BURTON, MONICA (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MITCHELL LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-6395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67 JACKS LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6152
Practice Address - Country:US
Practice Address - Phone:606-425-4371
Practice Address - Fax:606-699-1669
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240776103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-29702OtherBACB
14609077OtherCAQH
KY240776OtherCOMMONWEALTH OF KENTUCKY
KY7100590440Medicaid