Healthcare Provider Details

I. General information

NPI: 1831010214
Provider Name (Legal Business Name): AMY-JO MONGEAU BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ROSEWOOD DR STE 110
DANVERS MA
01923-1300
US

IV. Provider business mailing address

99 ROSEWOOD DR STE 110
DANVERS MA
01923-1300
US

V. Phone/Fax

Practice location:
  • Phone: 978-791-2219
  • Fax:
Mailing address:
  • Phone: 978-791-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: