MEDICARE: KIMBERLY ERIN MEADER BCBA, LABA

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	222Q00000X	Developmental Therapist
2	103K00000X	Behavior Analyst	2575	MA

General Provider Information

NPI Number	:	1518346998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ERIN MEADER BCBA, LABA

Provider Business Mailing Address
First Line	:	PO BOX 106
Second Line	:
City	:	HATFIELD
State	:	MA
Zip	:	01038-0106
Country	:	US
Telephone Number	:	508-247-6364
Fax Number	:	413-628-5262

Provider Business Practice Location Address
First Line	:	62 MAIN ST BLDG 2-3U
Second Line	:
City	:	HATFIELD
State	:	MA
Zip	:	01038-7920
Country	:	US
Telephone Number	:	413-247-6364
Fax Number	:	413-247-3857

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	05/22/2024

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