Provider Demographics
NPI:1003274259
Name:PULSIFER, DAVID (BCBA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:PULSIFER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 MAIN ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4106
Mailing Address - Country:US
Mailing Address - Phone:207-766-1880
Mailing Address - Fax:
Practice Address - Street 1:646 MAIN STREET
Practice Address - Street 2:APARTMENT 1
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092
Practice Address - Country:US
Practice Address - Phone:207-766-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-14-15901103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst