Provider Demographics
NPI:1962034520
Name:KIRCHEM-BUTTS, ABIGAIL TARLETON (BCBA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:TARLETON
Last Name:KIRCHEM-BUTTS
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 1:100 RESERVE RD STE F300
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5269
Mailing Address - Country:US
Mailing Address - Phone:203-429-5318
Mailing Address - Fax:203-628-4388
Practice Address - Street 1:100 RESERVE RD STE F300
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5269
Practice Address - Country:US
Practice Address - Phone:203-429-5318
Practice Address - Fax:203-628-4388
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-46896106S00000X
OR1-19-38623103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician