Healthcare Provider Details

I. General information

NPI: 1215784202
Provider Name (Legal Business Name): COMPASSIONATE BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 WINTER ST
ASHLAND MA
01721-1116
US

IV. Provider business mailing address

167 WINTER ST
ASHLAND MA
01721-1116
US

V. Phone/Fax

Practice location:
  • Phone: 508-625-0614
  • Fax:
Mailing address:
  • Phone: 508-625-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN A FISHER
Title or Position: CEO
Credential: BCBA LABA
Phone: 508-625-0614