Healthcare Provider Details

I. General information

NPI: 1265936835
Provider Name (Legal Business Name): PROVEN BEHAVIOR SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WASHINGTON ST STE P55
NORWELL MA
02061
US

IV. Provider business mailing address

80 WASHINGTON ST STE P55
NORWELL MA
02061-1742
US

V. Phone/Fax

Practice location:
  • Phone: 781-290-3886
  • Fax:
Mailing address:
  • Phone: 781-290-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1022025
License Number StateMA

VIII. Authorized Official

Name: SCOTT SNIDER
Title or Position: CEO
Credential:
Phone: 781-290-3886