Provider Demographics
NPI:1841854262
Name:HAHN, NATHAN CHRISTOPHER (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHRISTOPHER
Last Name:HAHN
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HINCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1907
Mailing Address - Country:US
Mailing Address - Phone:860-857-5964
Mailing Address - Fax:
Practice Address - Street 1:4 BROADWAY AVENUE EXT STE 3
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2875
Practice Address - Country:US
Practice Address - Phone:860-857-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT803103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst