Healthcare Provider Details

I. General information

NPI: 1912358813
Provider Name (Legal Business Name): ASPIRE LEARNING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 135C
BEVERLY MA
01915-6263
US

IV. Provider business mailing address

100 CUMMINGS CTR STE 135C
BEVERLY MA
01915-6263
US

V. Phone/Fax

Practice location:
  • Phone: 978-473-7300
  • Fax: 978-969-0083
Mailing address:
  • Phone: 978-473-7300
  • Fax: 978-969-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number000000964
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8125
License Number StateMA

VIII. Authorized Official

Name: MRS. TIFFANEY MARIE FRONGILLO
Title or Position: LICENSED APPLIED BEHAVIOR ANALYST
Credential: LABA, M.S., BCBA
Phone: 978-387-6563