Provider Demographics
NPI:1053660381
Name:HALL, DANA (DANA HALL, BCBA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:DANA HALL, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SANDERLING DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4756
Mailing Address - Country:US
Mailing Address - Phone:516-236-3961
Mailing Address - Fax:
Practice Address - Street 1:299 HALLOCK AVENUE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:516-236-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY1-10-7047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist