Kelsi Renninger, BCBA, LBS

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

12044762 Issued in PA

Practice address

175 E Brown St Ste 202
East Stroudsburg, PA 18301-3098

Phone

(570) 234-3989

Fax

(570) 209-5781

NPI assigned

Mar 15, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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.

• Matrix Behavior Solutions, LLC

  • Behavior Analyst
  • East Stroudsburg, PA
  • NPI 1760977649
  NPD (past)

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

{
    "created_epoch": "1678838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1871294918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E BROWN ST STE 202",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183013098",
            "telephone_number": "570-234-3989",
            "fax_number": "570-209-5781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 E BROWN ST STE 202",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183013098",
            "telephone_number": "570-234-3989",
            "fax_number": "570-209-5781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNINGER",
        "first_name": "KELSI",
        "credential": "BCBA, LBS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-15",
        "last_updated": "2023-03-15",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "BH005124",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "PA",
            "license": "12044762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyrie Regan, LSW
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• Padmanabha Rengabhashyam, MD
• Resources for Human Development, Inc
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• Restorative Family Services LLC
• Jose Angel Reyes, LAPC
• Deborah Reynolds, M.A.

• Behavior Analyst in East Stroudsburg, PA
• Providers in East Stroudsburg, PA by specialty
• Behavior Analyst in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.