Provider Demographics
NPI:1174198279
Name:CORNWELL, BRITTANY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CORNWELL
Suffix:
Gender:F
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 1:2916 PEACH BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8380
Mailing Address - Country:US
Mailing Address - Phone:812-202-6144
Mailing Address - Fax:
Practice Address - Street 1:2916 PEACH BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8380
Practice Address - Country:US
Practice Address - Phone:812-202-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IN1-21-55180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician