Healthcare Provider Details

I. General information

NPI: 1043789324
Provider Name (Legal Business Name): FELICIA ANNE EWING BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA VERVILLE

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ELM ST
WORCESTER MA
01609-2541
US

IV. Provider business mailing address

48 ELM ST
WORCESTER MA
01609-2541
US

V. Phone/Fax

Practice location:
  • Phone: 800-337-5965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10001880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: