Provider Demographics
NPI:1508217829
Name:PAKIELA, ADAM (BCBA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PAKIELA
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 1:1450 WASHINGTON BLVD
Mailing Address - Street 2:311-S
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2451
Mailing Address - Country:US
Mailing Address - Phone:203-994-3589
Mailing Address - Fax:
Practice Address - Street 1:30 BUXTON FARM RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1224
Practice Address - Country:US
Practice Address - Phone:203-674-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-16-22677103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst