Provider Demographics
NPI:1225727233
Name:SISSON, ROBERT WAYNE I (PHD BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:SISSON
Suffix:I
Gender:M
Credentials:PHD BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NH
Mailing Address - Zip Code:03846-0453
Mailing Address - Country:US
Mailing Address - Phone:603-733-8218
Mailing Address - Fax:
Practice Address - Street 1:2541 WHITE MOUNTAIN HWY BLDG 3
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5125
Practice Address - Country:US
Practice Address - Phone:603-733-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst