Provider Demographics
NPI:1760721138
Name:BROUGHAN, LEIGH ERIN (BCBA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ERIN
Last Name:BROUGHAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ERIN
Other - Last Name:WOODBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5680
Mailing Address - Country:US
Mailing Address - Phone:207-941-2952
Mailing Address - Fax:317-249-2248
Practice Address - Street 1:700 MOUNT HOPE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5680
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:317-249-2248
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-08-4876103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst