Healthcare Provider Details

I. General information

NPI: 1679015531
Provider Name (Legal Business Name): ELMTREE ABA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 BEACON ST
FRAMINGHAM MA
01701-4911
US

IV. Provider business mailing address

146 BEACON ST
FRAMINGHAM MA
01701-4911
US

V. Phone/Fax

Practice location:
  • Phone: 508-431-0053
  • Fax:
Mailing address:
  • Phone: 508-431-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number000000873
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number000000873
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number000000873
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number000000873
License Number StateMA

VIII. Authorized Official

Name: DR. LINDSAY CAROL PETERS
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D., BCBA-D, LABA
Phone: 508-431-0053