Provider Demographics
NPI:1184133845
Name:HARTNACK, LEANNA (BCBA)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:HARTNACK
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 1:274 LENOX ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-4016
Mailing Address - Country:US
Mailing Address - Phone:203-927-9712
Mailing Address - Fax:
Practice Address - Street 1:187 HALF MILE RD
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-4121
Practice Address - Country:US
Practice Address - Phone:203-234-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT14085701OtherCAQH