Healthcare Provider Details

I. General information

NPI: 1598129637
Provider Name (Legal Business Name): BEACON ABA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 FORTUNE BLVD SUITE 2
MILFORD MA
01757-1750
US

IV. Provider business mailing address

321 FORTUNE BLVD SUITE 2
MILFORD MA
01757-1750
US

V. Phone/Fax

Practice location:
  • Phone: 508-478-0207
  • Fax: 508-634-6984
Mailing address:
  • Phone: 508-478-0207
  • Fax: 508-634-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT LITTLETON
Title or Position: PRESIDENT
Credential: PHD
Phone: 508-473-3422