Healthcare Provider Details

I. General information

NPI: 1770725111
Provider Name (Legal Business Name): JONATHAN ALAN WORCESTER PH.D., NCSP, BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HOPE AVE
WORCESTER MA
01603-2212
US

IV. Provider business mailing address

81 HOPE AVE
WORCESTER MA
01603-2299
US

V. Phone/Fax

Practice location:
  • Phone: 508-320-4991
  • Fax:
Mailing address:
  • Phone: 508-983-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1020
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10000705
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number341
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: