1245537141 NPI number — DR. DONN CHARLES SOTTOLANO PH.D., BCBA-D

Table of content: DR. DONN CHARLES SOTTOLANO PH.D., BCBA-D (NPI 1245537141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245537141 NPI number — DR. DONN CHARLES SOTTOLANO PH.D., BCBA-D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTTOLANO
Provider First Name:
DONN
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., BCBA-D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245537141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-498-6800
Provider Business Mailing Address Fax Number:
203-498-6891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 OLD POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06472-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-484-9501
Provider Business Practice Location Address Fax Number:
203-484-9585
Provider Enumeration Date:
02/12/2011

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:  1095081 , 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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