Healthcare Provider Details

I. General information

NPI: 1306546015
Provider Name (Legal Business Name): PAIGE OLIVIA BRESNAHAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 CONVERSE ST
LONGMEADOW MA
01106-1763
US

IV. Provider business mailing address

180 DELANEY AVE
CHICOPEE MA
01013-1338
US

V. Phone/Fax

Practice location:
  • Phone: 413-384-2916
  • Fax:
Mailing address:
  • Phone: 413-297-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87590
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: