Healthcare Provider Details

I. General information

NPI: 1760919138
Provider Name (Legal Business Name): CATHERINE ANN AGRESTO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE ANN FARGO BCBA

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HMS STAYNER DR
HINGHAM MA
02043-1664
US

IV. Provider business mailing address

105 HMS STAYNER DR
HINGHAM MA
02043-1664
US

V. Phone/Fax

Practice location:
  • Phone: 617-957-6451
  • Fax: 781-385-7324
Mailing address:
  • Phone: 617-957-6451
  • Fax: 781-385-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1855-MH-B1
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1855
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: