Tracy Lynne Kettering, PH.D., BCBA-D

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1062808 Issued in NJ

Practice address

311 Walton Ave
Mount Laurel, NJ 08054-9579

Phone

(844) 234-8387

Fax

(856) 429-4755

NPI assigned

Oct 8, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bancroft Neurohealth

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mount Laurel, NJ
  • NPI 1598808941
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1376895870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 CALDWELL RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080343220",
            "telephone_number": "844-234-8387",
            "fax_number": "856-429-4755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 WALTON AVE",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080549579",
            "telephone_number": "844-234-8387",
            "fax_number": "856-429-4755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERING",
        "first_name": "TRACY",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "PH.D., BCBA-D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-08",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "1062808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Jo Anne Kelly, PMHNP-BC
• Meghan Patricia Kelly, NP
• Taylor Rose Kelly, LAC
• Walter T Kelso
• Joseph Kendorski, BCBA
• Allison Keyes, LSW
• Danial Khalifa, DPM
• Munaza Anwar Khan, MD
• Sophia S Khan, M.D
• Zubair Khan, D.O.

• Behavior Analyst in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Behavior Analyst in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.