Healthcare Provider Details

I. General information

NPI: 1922936731
Provider Name (Legal Business Name): ASHLEY SHAW BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 PINE ST STE 102
PEABODY MA
01960-3635
US

IV. Provider business mailing address

130 ADAMS AVE
SAUGUS MA
01906-3429
US

V. Phone/Fax

Practice location:
  • Phone: 978-717-5062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12689609
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: