Healthcare Provider Details

I. General information

NPI: 1083382162
Provider Name (Legal Business Name): JESSICA L CULLOO M.S. ASD, BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA EDWARDS

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAIN ST, BUILDING B SUITE 102
CHICOPEE MA
01020
US

IV. Provider business mailing address

300 E MAIN ST STE 200
MILFORD MA
01757-2806
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-0207
  • Fax: 508-634-6984
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1483
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: