Provider Demographics
NPI:1376048991
Name:TITCOMB, SANDRA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:TITCOMB
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:DUPLISEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 CHELSEY WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6888
Mailing Address - Country:US
Mailing Address - Phone:207-351-5606
Mailing Address - Fax:
Practice Address - Street 1:2 CHELSEY WAY
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6888
Practice Address - Country:US
Practice Address - Phone:207-351-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-21686103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst