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Individual

AMY C LEQUIRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA

Contact information

Practice address
44 HATCHETTS HILL RD, OLD LYME, CT 06371-1512
(860) 434-4800
(860) 434-4834
Mailing address
44 HATCHETTS HILL RD, OLD LYME, CT 06371-1512
(860) 434-4800
(860) 434-4834

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-06-3006
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
060883604
TAX ID
CT
01
1922123314
FACILITY NPI
CT
Enumeration date
12/18/2009
Last updated
12/18/2009
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