Katherine R Manettas, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-55065 Issued in GA

Practice address

30330 Hickey Rd
Chesterfield, MI 48051-3911

Phone

(586) 421-4062

NPI assigned

Nov 3, 2021

Last updated

Jul 19, 2024By the provider in NPPES

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

Practice roles

Locations

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

• The Center for Therapeutic Learning and Communication, PLLC

  dba Center for TLC

  • Rehabilitation Clinic/Center
  • Chesterfield, MI
  • NPI 1699966341

  Behavior Analyst

  NPD
• North Georgia Autism Center LLC.

  • Behavior Analyst
  • Woodstock, GA
  • NPI 1578048385
  NPD

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1801551940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30330 HICKEY RD",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480513911",
            "telephone_number": "586-421-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30330 HICKEY RD",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480513911",
            "telephone_number": "586-421-4062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3330 Chastain Meadows Pkwy NW Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kennesaw",
            "state": "GA",
            "postal_code": "301445881",
            "country_code": "US",
            "telephone_number": "678-648-7644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9940 Highway 92",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "GA",
            "postal_code": "301886417",
            "country_code": "US",
            "telephone_number": "470-473-5920",
            "fax_number": "888-979-8504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANETTAS",
        "first_name": "KATHERINE",
        "middle_name": "R",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-03",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-21-55065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Mallamo, DPM
• Lorelai Mallia
• Katrina Mallory
• Jordan Malos
• Cheyenne Malpress
• Amanda Rashella Mangas, MOT, OTR
• Aurora Mann
• Charnelle Mann
• Shandra Ann Manninen
• Jennifer Lynn Manning, A.T.,C

• Behavior Analyst in Chesterfield, MI
• Providers in Chesterfield, MI by specialty
• Behavior Analyst in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.