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NPI Code Detail

MEDICARE: ELIZABETH HOOPER BALA M.ED, BCBA

MEDICARE: ELIZABETH HOOPER BALA M.ED, BCBA
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
1103K00000XBehavior Analyst1-12-11457MA

General Provider Information

NPI Number : 1477978104
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH HOOPER BALA M.ED, BCBA
Provider Business Mailing Address
First Line : 55 ANN LEE RD
Second Line :
City : HARVARD
State : MA
Zip : 01451-1217
Country : US
Telephone Number : 978-391-1248
Fax Number :
Provider Business Practice Location Address
First Line : 55 ANN LEE RD
Second Line :
City : HARVARD
State : MA
Zip : 01451-1217
Country : US
Telephone Number : 978-391-1248
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2014
Last Update Date : 03/04/2014

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