Provider Demographics
NPI:1730626417
Name:RODERICK, SCOTT ALLYN (BCBA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALLYN
Last Name:RODERICK
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:163 LEAD MINE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:HARWINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06791-1315
Mailing Address - Country:US
Mailing Address - Phone:860-338-3130
Mailing Address - Fax:855-632-4963
Practice Address - Street 1:163 LEAD MINE BROOK RD
Practice Address - Street 2:
Practice Address - City:HARWINTON
Practice Address - State:CT
Practice Address - Zip Code:06791-1315
Practice Address - Country:US
Practice Address - Phone:860-338-3130
Practice Address - Fax:855-632-4963
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst