MEDICARE: COMPREHENSIVE BEHAVIORAL SERVICES

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	101YM0800X	Mental Health Counselor	5086	MA
2	103K00000X	Behavior Analyst	1-05-2179	MA

General Provider Information

NPI Number	:	1952708216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	749 ROCKY HILL RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-5523
Country	:	US
Telephone Number	:	774-269-8028
Fax Number	:	508-224-9823

Provider Business Practice Location Address
First Line	:	749 ROCKY HILL RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-5523
Country	:	US
Telephone Number	:	774-269-8028
Fax Number	:	508-224-9823

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. LYNN MARIE CORBETT
Credential	:	BCBA, LMHC
Telephone Number	:	774-269-8028

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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Directions to “COMPREHENSIVE BEHAVIORAL SERVICES ” Practice Location

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