Healthcare Provider Details

I. General information

NPI: 1841716933
Provider Name (Legal Business Name): APPLIED BEHAVIORAL ANALYSIS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MAIN ST STE 121
AMHERST MA
01002-2347
US

IV. Provider business mailing address

9 HUNT RD
NEW SALEM MA
01355-5507
US

V. Phone/Fax

Practice location:
  • Phone: 413-461-7120
  • Fax: 610-862-9094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1002
License Number StateMA

VIII. Authorized Official

Name: JESSICA A CHMYZINSKI
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA, LABA
Phone: 413-461-7120