Provider Demographics
NPI:1396546859
Name:FEDIGAN, SHANE (BCBA, LBA-CT)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:FEDIGAN
Suffix:
Gender:M
Credentials:BCBA, LBA-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 REYNOLDS FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3865
Mailing Address - Country:US
Mailing Address - Phone:203-794-2523
Mailing Address - Fax:
Practice Address - Street 1:802 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-4008
Practice Address - Country:US
Practice Address - Phone:203-794-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2086103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst