Kaitlin Licciardone, MS, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-17-26267 Issued in PA

Practice address

1019 W 9TH Ave
King of Prussia, PA 19406-1215

Phone

(610) 992-9900

NPI assigned

Sep 28, 2017

Sex

Female

Sole proprietor

Yes

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

Master of Science

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.

• Gym-Jam Therapeutics, Inc.

  • Community/Behavioral Health Agency
  • Pottsville, PA
  • NPI 1801337910

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506556800000",
    "number": "1669981908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 CITY AVE APT P212",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191311239",
            "telephone_number": "732-429-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 W 9TH AVE",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061215",
            "telephone_number": "610-992-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICCIARDONE",
        "first_name": "KAITLIN",
        "credential": "MS, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-28",
        "last_updated": "2017-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": "PA",
            "license": "1-17-26267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allen-Michael Lewis, LMFT
• Maureen Lewis, CRNP
• Jarvis Li
• Weiguo Victor Li, MD, MPH
• Daniel Libby
• Benjamin Edward Lief, PSY.D.
• Nguyenthuy Lieu
• Life Waves Counseling and Mediation
• Light the Lamp Physical Therapy LLC
• Hyo J Lim, D.M.D

• Behavior Analyst in King of Prussia, PA
• Providers in King of Prussia, PA by specialty
• Behavior Analyst in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; 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.