=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184448284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABA NEW ENGLAND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2024
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 EMERSON RD
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03055-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-732-3415
-----------------------------------------------------
Fax | 703-754-3867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5501 MERCHANTS VIEW SQ STE 743
-----------------------------------------------------
City | HAYMARKET
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20169-5439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-732-3415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PERRY OLSON
-----------------------------------------------------
Credential | BCBA, LBA
-----------------------------------------------------
Telephone | 603-732-3415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------