Provider Demographics
NPI:1952618654
Name:ROSCOE, LYNDSAY (BCBA)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:ROSCOE
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 1:279 NEW BRITAIN RD STE 9
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3165
Mailing Address - Country:US
Mailing Address - Phone:860-827-9364
Mailing Address - Fax:860-292-1518
Practice Address - Street 1:279 NEW BRITAIN RD STE 9
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3165
Practice Address - Country:US
Practice Address - Phone:860-827-9364
Practice Address - Fax:860-292-1518
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT754103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst