Provider Demographics
NPI:1639862899
Name:PRINCE, JOSEPH (NCSP, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:PRINCE
Suffix:
Gender:M
Credentials:NCSP, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1652
Mailing Address - Country:US
Mailing Address - Phone:860-984-8391
Mailing Address - Fax:
Practice Address - Street 1:90 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1652
Practice Address - Country:US
Practice Address - Phone:860-984-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1382103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst