Healthcare Provider Details

I. General information

NPI: 1154009561
Provider Name (Legal Business Name): ANDREW BRODEUR BCBA, LABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PERIMETER RD
NASHUA NH
03063-1301
US

IV. Provider business mailing address

53 BEDFORD RD
MERRIMACK NH
03054-2804
US

V. Phone/Fax

Practice location:
  • Phone: 603-600-3201
  • Fax:
Mailing address:
  • Phone: 339-788-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10000315
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: