/Keona Denee Clark
Individual provider Active NPI Behavior Analyst · Mendham, NJ
NPI 1124359963 · NPPES record last updated Jan 19, 2010
Key facts
- NPI
- 1124359963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- Practice address
- 80 W Main St
Mendham, NJ 07945-1257 - Phone
- (973) 543-5656
- NPI assigned
- Jan 19, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Yes |
Addresses
Primary practice location
80 W Main St
Mendham, NJ 07945-1257
Mailing address
80 W Main St
Mendham, NJ 07945-1257
Phone (973) 543-5656
Other providers in Mendham, NJ
- Samantha Cataldo
- Laura Rina Cecchetto
- John Cerrato
- Abraham Chan
- Nicholas Ciolek
- Josephine Ann Cleary
- Mario Coleman
- Allison Carthan Connolly
- Cornerstone Pharmacy LLC
- Rachel Aubrey Coulther
All providers in Mendham, NJ · Behavior Analyst in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.