Provider Demographics
NPI:1629318944
Name:BURRUSS, IAN P (BCBA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:P
Last Name:BURRUSS
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:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06050-0984
Mailing Address - Country:US
Mailing Address - Phone:860-827-9364
Mailing Address - Fax:
Practice Address - Street 1:279 NEW BRITAIN RD STE 9
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3165
Practice Address - Country:US
Practice Address - Phone:860-827-9364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-10-7394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst