Provider Demographics
NPI:1265984892
Name:NAULT, ANDREA (MA, MS, BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NAULT
Suffix:
Gender:F
Credentials:MA, MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 N MCQUEEN RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8136
Mailing Address - Country:US
Mailing Address - Phone:860-208-5365
Mailing Address - Fax:
Practice Address - Street 1:957 N MCQUEEN RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8136
Practice Address - Country:US
Practice Address - Phone:860-208-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11830934103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid