Provider Demographics
NPI:1033861794
Name:WHITEHEAD, HAROLD LEE JR (BCBA)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:LEE
Last Name:WHITEHEAD
Suffix:JR
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 1:3 ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3239
Mailing Address - Country:US
Mailing Address - Phone:203-501-9131
Mailing Address - Fax:
Practice Address - Street 1:3 ASHWOOD LN
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-3239
Practice Address - Country:US
Practice Address - Phone:203-501-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12148029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst