Provider Demographics
NPI:1255877726
Name:DAFFINRUD, COURTNEY MARIE (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MARIE
Last Name:DAFFINRUD
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:KIRBY
Mailing Address - State:VT
Mailing Address - Zip Code:05851
Mailing Address - Country:US
Mailing Address - Phone:802-999-2513
Mailing Address - Fax:
Practice Address - Street 1:878 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:KIRBY
Practice Address - State:VT
Practice Address - Zip Code:05851
Practice Address - Country:US
Practice Address - Phone:802-999-2513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT103K00000X
NH103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst