Provider Demographics
NPI:1205405933
Name:MADDOX, JUSTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MADDOX
Suffix:
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 1:218 EAST RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2305
Mailing Address - Country:US
Mailing Address - Phone:603-329-5311
Mailing Address - Fax:
Practice Address - Street 1:218 EAST RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2305
Practice Address - Country:US
Practice Address - Phone:603-329-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22928103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst