Provider Demographics
NPI:1851916829
Name:LUDDEN, DIANE L (BCBA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:LUDDEN
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 1:45 JOHANSEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4914
Mailing Address - Country:US
Mailing Address - Phone:207-749-3826
Mailing Address - Fax:
Practice Address - Street 1:70 BAYVIEW ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6993
Practice Address - Country:US
Practice Address - Phone:207-847-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-19-37170103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst