Healthcare Provider Details

I. General information

NPI: 1376453514
Provider Name (Legal Business Name): NATHAN TAYLOR BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LOUDON RD
CONCORD NH
03301-5601
US

IV. Provider business mailing address

9 THORNDIKE RD
WINDHAM NH
03087-1125
US

V. Phone/Fax

Practice location:
  • Phone: 650-479-4419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43905
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: