Healthcare Provider Details

I. General information

NPI: 1285236075
Provider Name (Legal Business Name): BLUE GEMS ABA MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST FL 14
BOSTON MA
02114-2509
US

IV. Provider business mailing address

100 CAMBRIDGE ST FL 14
BOSTON MA
02114-2509
US

V. Phone/Fax

Practice location:
  • Phone: 617-297-7998
  • Fax:
Mailing address:
  • Phone: 617-297-7998
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WOLF
Title or Position: CEO
Credential:
Phone: 617-297-7998