MEDICARE: SEAN CORIATY MA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1861841330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN CORIATY MA BCBA

Provider Business Mailing Address
First Line	:	229 RICE HILL RD
Second Line	:
City	:	FREEDOM
State	:	NH
Zip	:	03836-5034
Country	:	US
Telephone Number	:	603-452-8284
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 RICE HILL RD
Second Line	:
City	:	FREEDOM
State	:	NH
Zip	:	03836-5034
Country	:	US
Telephone Number	:	603-452-8284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	06/06/2016

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