=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891450573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY FROST BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2021
-----------------------------------------------------
Last Update Date | 11/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 SAUNDERS WAY STE 720
-----------------------------------------------------
City | WESTBROOK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04092-4834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-523-5126
-----------------------------------------------------
Fax | 207-464-6000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 ROBIE ST
-----------------------------------------------------
City | GORHAM
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04038-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-313-6926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1--21-54021
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------