Provider Demographics
NPI:1538600291
Name:HALL, DYLAN EDWARD (BCBA)
Entity type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:EDWARD
Last Name:HALL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HMS STAYNER DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1664
Mailing Address - Country:US
Mailing Address - Phone:617-957-6451
Mailing Address - Fax:781-385-7324
Practice Address - Street 1:105 HMS STAYNER DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1664
Practice Address - Country:US
Practice Address - Phone:617-957-6451
Practice Address - Fax:781-385-7324
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA1745103K00000X
1-16-22151103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst