Provider Demographics
NPI:1962869297
Name:GEORGE, PATRICIA (BCBA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GEORGE
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 1:5 RIVER RD
Mailing Address - Street 2:SUTIE 142
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4069
Mailing Address - Country:US
Mailing Address - Phone:646-206-1296
Mailing Address - Fax:888-761-5161
Practice Address - Street 1:5 RIVER RD
Practice Address - Street 2:SUTIE 142
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4069
Practice Address - Country:US
Practice Address - Phone:646-206-1296
Practice Address - Fax:888-761-5161
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst