Healthcare Provider Details

I. General information

NPI: 1770067100
Provider Name (Legal Business Name): CHEYENNE PITCHER BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHEYENNE NETTLETON

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MAIN ST STE G
EAST HARTFORD CT
06118-3239
US

IV. Provider business mailing address

50 FAIRFAX AVE
MERIDEN CT
06451-2725
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 860-921-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1160
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: