Provider Demographics
NPI:1134368632
Name:HANLON, CAROLE RYAN (BCBA, LPC (PENDING))
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:RYAN
Last Name:HANLON
Suffix:
Gender:F
Credentials:BCBA, LPC (PENDING)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9729
Mailing Address - Country:US
Mailing Address - Phone:413-569-5638
Mailing Address - Fax:
Practice Address - Street 1:94 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9729
Practice Address - Country:US
Practice Address - Phone:413-306-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CT001841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst