Provider Demographics
NPI:1467876474
Name:FATTORE, CHRISTIE (BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:FATTORE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4101
Mailing Address - Country:US
Mailing Address - Phone:513-874-6789
Mailing Address - Fax:513-874-6787
Practice Address - Street 1:305 CAMERON RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-4101
Practice Address - Country:US
Practice Address - Phone:513-874-6789
Practice Address - Fax:513-874-6787
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11210292103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst