Provider Demographics
NPI:1063818821
Name:DEBRODER, CATHERINE (BCBA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DEBRODER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:C
Other - Last Name:DEBRODER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:15 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:804 W BANK ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5126
Practice Address - Country:US
Practice Address - Phone:336-416-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1466103K00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No252Y00000XAgenciesEarly Intervention Provider Agency