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General NPI Number Information
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NPI Number | 1225403256
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH SASSIN II BCBA
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Gender | Male
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 51 MORNINGSIDE DR
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City | MIDDLEBURY
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State | VT
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Zip | 05753-1075
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Country | US
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Telephone | 802-398-7428
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Fax |
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Provider Business Mailing Address
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Address Line | 51 MORNINGSIDE DR
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City | MIDDLEBURY
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State | VT
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Zip | 05753-1075
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Country | US
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Telephone | 802-398-7428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1149947
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License Number State |
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