Provider Demographics
NPI:1649475682
Name:SMALL, CATHLEEN J (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:J
Last Name:SMALL
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
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Mailing Address - Street 1:1577 CONGRESS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2169
Mailing Address - Country:US
Mailing Address - Phone:207-662-5522
Mailing Address - Fax:207-774-1814
Practice Address - Street 1:301C US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9701
Practice Address - Country:US
Practice Address - Phone:207-396-8600
Practice Address - Fax:207-396-8632
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD04783103T00000X
1-05-2441103K00000X
MEPS1380103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst