Provider Demographics
NPI:1447039136
Name:SADLOW, MIRANDA (MS, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:SADLOW
Suffix:
Gender:F
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MA
Mailing Address - Zip Code:01270-0271
Mailing Address - Country:US
Mailing Address - Phone:413-242-4816
Mailing Address - Fax:
Practice Address - Street 1:100 HUMES RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MA
Practice Address - Zip Code:01270-9298
Practice Address - Country:US
Practice Address - Phone:413-372-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000065103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst