Provider Demographics
NPI:1770067100
Name:PITCHER, CHEYENNE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:PITCHER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:
Other - Last Name:NETTLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2725
Mailing Address - Country:US
Mailing Address - Phone:860-921-8603
Mailing Address - Fax:
Practice Address - Street 1:144 MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-3239
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
CT1160103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist