Individual
DR. KEISHA POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, CAS, ABS, ATS
Contact information
Practice address
3 JESSIE LN, BROAD BROOK, CT 06016-9596
(860) 983-8112
Mailing address
3 JESSIE LN, BROAD BROOK, CT 06016-9596
(860) 983-8112
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
C072017000387
CT
174400000X
Specialist
Primary
CAS176247
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080-96340
—
CT
01
—
23907
BOARD CERTIFIED SEXOLOGIST
FL
01
—
C072017000387
SPECIAL EDUCATION-AUTISM
CT
01
—
CAS176247
CERTIFIED AUTISM SPECIALIST
FL
Enumeration date
04/25/2014
Last updated
10/09/2024
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