Healthcare Provider Details

I. General information

NPI: 1386369866
Provider Name (Legal Business Name): COLLABABLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 CLAPP RD
SCITUATE MA
02066-3015
US

IV. Provider business mailing address

278 CLAPP RD
SCITUATE MA
02066-3015
US

V. Phone/Fax

Practice location:
  • Phone: 781-738-4886
  • Fax:
Mailing address:
  • Phone: 781-738-4886
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA EVERETT
Title or Position: FOUNDER
Credential: PH.D., BCBA-D, LABA
Phone: 781-738-4886