Healthcare Provider Details

I. General information

NPI: 1225330467
Provider Name (Legal Business Name): RYAN K BAKER-BARRETT BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RYAN K KNIGHTON BCBA

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 05/26/2024
Certification Date: 05/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOLT ST
WATERTOWN MA
02472-1019
US

IV. Provider business mailing address

105 HOLT ST
WATERTOWN MA
02472-1019
US

V. Phone/Fax

Practice location:
  • Phone: 435-363-6789
  • Fax:
Mailing address:
  • Phone: 435-363-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA2370
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-12588
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: