Healthcare Provider Details

I. General information

NPI: 1992008981
Provider Name (Legal Business Name): NATIVIDAD RODRIGUEZ LABA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ROBBS HILL RD
LUNENBURG MA
01462-2167
US

IV. Provider business mailing address

3 TURIN RD # 2
WORCESTER MA
01604-1825
US

V. Phone/Fax

Practice location:
  • Phone: 774-270-1766
  • Fax:
Mailing address:
  • Phone: 269-598-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2065
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: