Healthcare Provider Details

I. General information

NPI: 1861999880
Provider Name (Legal Business Name): BEHAVIOR INTEGRATED LEARNING & DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST SUITE 400 WEST
BURLINGTON MA
01803-5108
US

IV. Provider business mailing address

67 S BEDFORD ST SUITE 400 WEST
BURLINGTON MA
01803-5108
US

V. Phone/Fax

Practice location:
  • Phone: 844-333-2453
  • Fax: 844-333-2453
Mailing address:
  • Phone: 844-333-2453
  • Fax: 844-333-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GRACE J KARUE
Title or Position: PRESIDENT
Credential:
Phone: 844-333-2453