=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528911773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX DEVELOPMENTAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2026
-----------------------------------------------------
Last Update Date | 02/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79 BRIDLE PATH CIR
-----------------------------------------------------
City | RANDOLPH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02368-4453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-407-3666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 BRIDLE PATH CIR
-----------------------------------------------------
City | RANDOLPH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02368-4453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-407-3666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | ROBERT A GRIGORE
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 617-407-3666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------