Provider Demographics
NPI:1164922241
Name:WILLIAMSON, IAN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 BANK ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6083
Mailing Address - Country:US
Mailing Address - Phone:860-495-3658
Mailing Address - Fax:
Practice Address - Street 1:88 BANK ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6083
Practice Address - Country:US
Practice Address - Phone:860-495-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1191103K00000X
CT887103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-38401OtherBCBA CERTIFICATE