Healthcare Provider Details

I. General information

NPI: 1801208889
Provider Name (Legal Business Name): JULIE HAYDEN BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 01/16/2021
Certification Date: 01/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MECHANIC ST # 484
EAST BROOKFIELD MA
01515-9800
US

IV. Provider business mailing address

103 MECHANIC ST # 484
EAST BROOKFIELD MA
01515-9800
US

V. Phone/Fax

Practice location:
  • Phone: 413-459-9565
  • Fax: 833-431-1244
Mailing address:
  • Phone: 508-523-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1634
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: