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General NPI Number Information
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NPI Number | 1609731579
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Entity Type | Organization
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Legal Business Name | BRIGHTLEAF BEHAVIORAL SUPPORT
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 121 MONADNOCK ST
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City | GARDNER
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State | MA
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Zip | 01440-2103
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Country | US
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Telephone | 774-386-4659
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Fax |
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Provider Business Mailing Address
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Address Line | 121 MONADNOCK ST
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City | GARDNER
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State | MA
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Zip | 01440-2103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE CLINICAL DIRECTOR
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Name | SAMANTHA HASKINS
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Credential | BCBA
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Telephone | 802-782-6562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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