Basic Information
| Provider Information | |||||||||
| NPI: | 1831669597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLUSKEY | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 599 NORTH AVE # 9 | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018801648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813544500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 599 NORTH AVE # 9 | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018801648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813544500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2018 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.