Provider Demographics
NPI:1174911143
Name:BREWER, KRISTINE (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:PLANKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1261 BERLIN TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037
Mailing Address - Country:US
Mailing Address - Phone:860-933-5751
Mailing Address - Fax:888-257-1805
Practice Address - Street 1:1261 BERLIN TURNPIKE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037
Practice Address - Country:US
Practice Address - Phone:860-933-5751
Practice Address - Fax:888-257-1805
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2024-02-27
Deactivation Date:2023-08-18
Deactivation Code:
Reactivation Date:2024-02-27
Provider Licenses
StateLicense IDTaxonomies
CT67103K00000X
CT1-12-12036103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst