Healthcare Provider Details

I. General information

NPI: 1679114474
Provider Name (Legal Business Name): APPLIED BEHAVIOR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BOSTON POST RD W STE 135
MARLBOROUGH MA
01752-1898
US

IV. Provider business mailing address

65 BOSTON POST RD W STE 135
MARLBOROUGH MA
01752-1898
US

V. Phone/Fax

Practice location:
  • Phone: 617-402-5444
  • Fax: 508-519-9188
Mailing address:
  • Phone: 617-402-5444
  • Fax: 508-519-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE BENOTTI
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 508-767-5254