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General NPI Number Information
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NPI Number | 1649475682
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Entity Type | Individual
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Provider Name | CATHLEEN J SMALL PH.D., BCBA-D
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | 301C US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Provider Business Mailing Address
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Address Line | 1577 CONGRESS ST 2ND FLOOR
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City | PORTLAND
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State | ME
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Zip | 04102-2169
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Country | US
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Telephone | 207-662-5522
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Fax | 207-774-1814
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04783
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-05-2441
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS1380
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License Number State | ME
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