Provider Demographics
NPI:1578949798
Name:RATLLIFF, SIOBHAN SUMMER (MS BCBA, LABA)
Entity Type:Individual
Prefix:MRS
First Name:SIOBHAN
Middle Name:SUMMER
Last Name:RATLLIFF
Suffix:
Gender:F
Credentials:MS BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 S UNION ST STE 116
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2837
Mailing Address - Country:US
Mailing Address - Phone:800-679-3609
Mailing Address - Fax:
Practice Address - Street 1:439 S UNION ST STE 116
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2837
Practice Address - Country:US
Practice Address - Phone:800-679-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10000142103K00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist