Provider Demographics
NPI:1427879998
Name:HATFIELD, NATANIELLE RAE (BCBA)
Entity type:Individual
Prefix:
First Name:NATANIELLE
Middle Name:RAE
Last Name:HATFIELD
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 1:311 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2032
Mailing Address - Country:US
Mailing Address - Phone:860-710-0516
Mailing Address - Fax:
Practice Address - Street 1:311 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2032
Practice Address - Country:US
Practice Address - Phone:860-710-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTBA.000985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst