Kylie Haven Vaccarelli, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1640 Issued in CT

Practice address

42 Grove St
Ansonia, CT 06401-1753

Phone

(203) 736-5095

NPI assigned

Apr 21, 2023

Reactivated

Oct 13, 2023

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

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.

• Ansonia Public School District, Ansonia Board of Education

  • Local Education Agency (LEA)
  • Ansonia, CT
  • NPI 1801957899
  NPD (past)

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697241600000",
    "number": "1598452294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 W RIVER ST APT 15",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064612695",
            "telephone_number": "203-558-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 GROVE ST",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "064011753",
            "telephone_number": "203-736-5095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Progress Dr",
            "address_purpose": "LOCATION",
            "city": "Shelton",
            "state": "CT",
            "postal_code": "064846293",
            "country_code": "US",
            "telephone_number": "475-239-5512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VACCARELLI",
        "first_name": "KYLIE",
        "middle_name": "HAVEN",
        "credential": "BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-10-14",
        "certification_date": "2023-10-14",
        "deactivation_date": "2023-10-05",
        "reactivation_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CT",
            "license": "1640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Ansonia, CT
• Providers in Ansonia, CT by specialty
• Behavior Analyst in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2023; 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.