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General NPI Number Information
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NPI Number | 1417312943
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Entity Type | Individual
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Provider Name | COLEEN SUTHERLAND BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 15 SCHOOL STREET
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City | EAST GRANBY
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State | CT
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Zip | 06026
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Country | US
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Telephone | 860-413-9538
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CHURCHILL LN
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City | WESTBROOK
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State | CT
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Zip | 06498-1532
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Country | US
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Telephone |
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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 | 1-15-18408
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License Number State | CT
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