Provider Demographics
NPI:1104450766
Name:DIXON, RUEL (BCBA)
Entity type:Individual
Prefix:
First Name:RUEL
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STATE ST APT 85
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2219
Mailing Address - Country:US
Mailing Address - Phone:860-985-9779
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ST APT 85
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2219
Practice Address - Country:US
Practice Address - Phone:860-985-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst