Individual
KHADEJHA KETTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
950 UNDERHILL AVE APT 19C, BRONX, NY 10473-2731
(646) 281-6914
Mailing address
950 UNDERHILL AVE APT 19C, BRONX, NY 10473-2731
(646) 281-6914
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1383458201
NY
106E00000X
Assistant Behavior Analyst
1383458201
NY
Other
Enumeration date
02/02/2020
Last updated
02/02/2020
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