Basic Information
| Provider Information | |||||||||
| NPI: | 1053823898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATES | ||||||||
| FirstName: | SERENA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | BCBA, LABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017203575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782631427 | ||||||||
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| Practice Location | |||||||||
| Address1: | 51 WATER ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024724611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179237575 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2017 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-20-42969 | MA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.