Basic Information
| Provider Information | |||||||||
| NPI: | 1386316917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | DANIEL | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 NORTH AVENUE | ||||||||
| Address2: | FL 2 DOOR 11 | ||||||||
| City: | WAKEFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669264345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1266 FURNACE BROOK PKWY STE 410 | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669264345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2021 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-20-45074 | MA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.