Provider Demographics
NPI:1679052948
Name:NOVEMBER, KAILA RAE (MED, BCBA, COBA)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:RAE
Last Name:NOVEMBER
Suffix:
Gender:F
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, COBA
Mailing Address - Street 1:1418 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1622
Mailing Address - Country:US
Mailing Address - Phone:419-351-1689
Mailing Address - Fax:
Practice Address - Street 1:3570 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5288
Practice Address - Country:US
Practice Address - Phone:216-282-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00454103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-31007OtherBCBA CERTIFICATE