Basic Information
| Provider Information | |||||||||
| NPI: | 1255064721 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOSTON BEHAVIOR LEARNING CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 OAK ST STE G20 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024641492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176585611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 OAK ST STE G20 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024641492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176585611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2022 | ||||||||
| LastUpdateDate: | 07/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIAZ | ||||||||
| AuthorizedOfficialFirstName: | TESSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BEHAVIOR TECHNICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6175167713 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.