Provider Demographics
NPI:1790479038
Name:HALL, SHARESE T (BCBA)
Entity type:Individual
Prefix:MS
First Name:SHARESE
Middle Name:T
Last Name:HALL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1629
Mailing Address - Country:US
Mailing Address - Phone:850-543-9945
Mailing Address - Fax:
Practice Address - Street 1:10304 EATON PL STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2221
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:888-588-2752
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0133004166103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty