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Behavioral Analyst

Old Lyme, Connecticut

Provider NPI: 1326377425

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 860-434-4800  Fax: 860-434-4834

Business Mailing Address:
Tel: 860-434-4800  Fax: 860-434-4834

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number


Other Provider Identifiers:

TAX ID060883604CT01
FACILITY NPI1922123314CT01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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