Provider Demographics
NPI:1689499592
Name:OGLESBY, DANIEL (BCBA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BENDER RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2052
Mailing Address - Country:US
Mailing Address - Phone:203-808-2807
Mailing Address - Fax:
Practice Address - Street 1:121 BENDER RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2052
Practice Address - Country:US
Practice Address - Phone:203-808-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT628103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst