Provider Demographics
NPI:1750727780
Name:DADIAN, ELIZABETH ANOUSH (BCBA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANOUSH
Last Name:DADIAN
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 1:12 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WOODS HOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02543-1125
Mailing Address - Country:US
Mailing Address - Phone:307-213-9554
Mailing Address - Fax:
Practice Address - Street 1:12 PARK RD
Practice Address - Street 2:
Practice Address - City:WOODS HOLE
Practice Address - State:MA
Practice Address - Zip Code:02543-1125
Practice Address - Country:US
Practice Address - Phone:307-213-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-11419103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst