Healthcare Provider Details

I. General information

NPI: 1851774152
Provider Name (Legal Business Name): CHRISTIAN PERDOMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 DONALD LYNCH BLVD
MARLBOROUGH MA
01752-4702
US

IV. Provider business mailing address

295 DONALD LYNCH BLVD
MARLBOROUGH MA
01752-4702
US

V. Phone/Fax

Practice location:
  • Phone: 508-651-7500
  • Fax:
Mailing address:
  • Phone: 508-651-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10000561
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: