Healthcare Provider Details

I. General information

NPI: 1689236820
Provider Name (Legal Business Name): AMELIA BEATRICE ANDREWS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMELIA BEATRICE DESJARDINS BCBA

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date: 04/27/2021
Reactivation Date: 05/18/2021

III. Provider practice location address

1 RIVER ST
ERVING MA
01344-4403
US

IV. Provider business mailing address

1 RIVER ST
ERVING MA
01344-4403
US

V. Phone/Fax

Practice location:
  • Phone: 413-776-4422
  • Fax:
Mailing address:
  • Phone: 413-776-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49462
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: