Provider Demographics
NPI:1861945420
Name:BISAILLON, DEANNA (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:BISAILLON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOLCOMB ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1529
Mailing Address - Country:US
Mailing Address - Phone:860-965-8218
Mailing Address - Fax:
Practice Address - Street 1:120 HOLCOMB ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1529
Practice Address - Country:US
Practice Address - Phone:860-965-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-14-15864103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst