1043536030 NPI number — MRS. KRISTA SCHERMERHORN BORDELEAU MA ED., BCBA

Table of content: MRS. KRISTA SCHERMERHORN BORDELEAU MA ED., BCBA (NPI 1043536030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043536030 NPI number — MRS. KRISTA SCHERMERHORN BORDELEAU MA ED., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORDELEAU
Provider First Name:
KRISTA
Provider Middle Name:
SCHERMERHORN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA ED., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHERMERHORN
Provider Other First Name:
KRISTA
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA ED.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043536030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEDYARD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06339-0306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-381-5537
Provider Business Mailing Address Fax Number:
860-381-5712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
758R COLONEL LEDYARD HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEDYARD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06339-1570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-381-5537
Provider Business Practice Location Address Fax Number:
860-381-5712
Provider Enumeration Date:
04/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-08-4271 (BCBA) , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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