MEDICARE: MRS. MARY A SHERLOCK MS BCBA LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	3945	MA

General Provider Information

NPI Number	:	1427798677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY A SHERLOCK MS BCBA LBA

Provider Business Mailing Address
First Line	:	11 S GARDEN ST
Second Line	:
City	:	UXBRIDGE
State	:	MA
Zip	:	01569-1744
Country	:	US
Telephone Number	:	508-272-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 S GARDEN ST
Second Line	:
City	:	UXBRIDGE
State	:	MA
Zip	:	01569-1744
Country	:	US
Telephone Number	:	508-272-7704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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