Healthcare Provider Details

I. General information

NPI: 1619367695
Provider Name (Legal Business Name): ROBIN BOTHAM MESSIER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 OTROBANDO AVE SUITE B
NORWICH CT
06033-2116
US

IV. Provider business mailing address

6 DEPOT ROAD EXT
CANTERBURY CT
06331-1912
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 860-377-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCT0267
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA3680
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11416556
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: