Provider Demographics
NPI:1679076400
Name:ROSS, KASEY MILLER (BCBA)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:MILLER
Last Name:ROSS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1003
Mailing Address - Country:US
Mailing Address - Phone:908-246-0448
Mailing Address - Fax:
Practice Address - Street 1:60 FERRY RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:NJ
Practice Address - Zip Code:08559-1003
Practice Address - Country:US
Practice Address - Phone:908-246-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11623896103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst