Provider Demographics
NPI:1457897696
Name:REID, BREIANNA (BCBA)
Entity Type:Individual
Prefix:
First Name:BREIANNA
Middle Name:
Last Name:REID
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 1:215 E MAIN ST
Mailing Address - Street 2:APT 2J
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3351
Mailing Address - Country:US
Mailing Address - Phone:860-256-1014
Mailing Address - Fax:
Practice Address - Street 1:162 WEST ST
Practice Address - Street 2:BUILDING 2, SUITE F
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4404
Practice Address - Country:US
Practice Address - Phone:860-613-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-16-23139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst