Active NPI
Kellie Ann Mastrogiovanni, LBA
- Behavior Analyst
- Waterbury, CT
National Provider Identifier
1134815723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 2075
- Practice address
- 276 Highland Ave
Waterbury, CT 06708-3022 - Phone
- (475) 414-5800
- NPI assigned
- Apr 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | 2075 | CT | Primary |
Addresses
Primary practice location
276 Highland Ave
Waterbury, CT 06708-3022
Mailing address
263 Laurel Hill Rd Apt 8
Torrington, CT 06790-5714
Phone (860) 459-9717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2075 | CT | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743120000000",
"number": "1134815723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "263 LAUREL HILL RD APT 8",
"city": "TORRINGTON",
"state": "CT",
"postal_code": "067905714",
"telephone_number": "860-459-9717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "276 HIGHLAND AVE",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067083022",
"telephone_number": "475-414-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASTROGIOVANNI",
"first_name": "KELLIE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-17",
"last_updated": "2025-03-28",
"certification_date": "2025-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CT",
"license": "2075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.