Healthcare Provider Details

I. General information

NPI: 1356937056
Provider Name (Legal Business Name): REILLY L WALDRON BCBA, LABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 GROTON RD
WESTFORD MA
01886-6321
US

IV. Provider business mailing address

9 EASTERN AVE
BURLINGTON MA
01803-2203
US

V. Phone/Fax

Practice location:
  • Phone: 800-679-3609
  • Fax:
Mailing address:
  • Phone: 781-724-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10001150
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: