Healthcare Provider Details

I. General information

NPI: 1336698299
Provider Name (Legal Business Name): APPLIED BEHAVIORAL LEARNING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHRYSLER RD APT 1001
NATICK MA
01760-1650
US

IV. Provider business mailing address

1 CHRYSLER RD APT 1001
NATICK MA
01760-1650
US

V. Phone/Fax

Practice location:
  • Phone: 617-283-1276
  • Fax:
Mailing address:
  • Phone: 617-283-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1123
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number949
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1002
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7783
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number749
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARIELA VARGAS-IRWIN
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D., BCBA, LABA
Phone: 617-283-1276