Provider Demographics
NPI:1740621952
Name:REMINGTON-FOX, SUZANNE ADRIANA (BCBA)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ADRIANA
Last Name:REMINGTON-FOX
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 1:185 CHIPMAN DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3175
Mailing Address - Country:US
Mailing Address - Phone:203-272-2471
Mailing Address - Fax:
Practice Address - Street 1:185 CHIPMAN DR
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3175
Practice Address - Country:US
Practice Address - Phone:203-272-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-13-13461103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1-13-13461OtherBLUE CROSS
CT1-13-13461Medicaid