Healthcare Provider Details

I. General information

NPI: 1043654106
Provider Name (Legal Business Name): WENDY B GREENHALGH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAIN ST #102
WATERTOWN MA
02472-4411
US

IV. Provider business mailing address

85 MAIN ST #102
WATERTOWN MA
02472-4411
US

V. Phone/Fax

Practice location:
  • Phone: 617-923-1300
  • Fax: 617-663-6252
Mailing address:
  • Phone: 617-923-1300
  • Fax: 617-663-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: