Healthcare Provider Details

I. General information

NPI: 1407228836
Provider Name (Legal Business Name): NEW ENGLAND ABA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2015
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 NORTH AVE DOOR 11 FLOOR 2
WAKEFIELD MA
01880-1322
US

IV. Provider business mailing address

607 NORTH AVE DOOR 11 FLOOR 2
WAKEFIELD MA
01880-1322
US

V. Phone/Fax

Practice location:
  • Phone: 866-926-4345
  • Fax: 781-557-5012
Mailing address:
  • Phone: 866-926-4345
  • Fax: 781-557-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11981
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY COLEMAN SULLIVAN
Title or Position: FOUNDER AND CEO
Credential: BCBA
Phone: 774-313-0981