Provider Demographics
NPI:1740599208
Name:MCQUADE, RACHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:MCQUADE
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 1:660 PADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7018
Mailing Address - Country:US
Mailing Address - Phone:203-631-7916
Mailing Address - Fax:
Practice Address - Street 1:660 PADDOCK AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7018
Practice Address - Country:US
Practice Address - Phone:203-631-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-10-7178103K00000X
CT6432014330222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT$$$$$$$$$OtherSOCIAL SECURITY NUMBER