Healthcare Provider Details

I. General information

NPI: 1326914334
Provider Name (Legal Business Name): MY STOMPING GROUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 HIGHLAND AVE
PHILLIPSTON MA
01331-9764
US

IV. Provider business mailing address

12 ROYALSTON RD
PHILLIPSTON MA
01331-9401
US

V. Phone/Fax

Practice location:
  • Phone: 978-549-0361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WOOD
Title or Position: PRESIDENT
Credential:
Phone: 978-549-0361