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General NPI Number Information
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NPI Number | 1942672506
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Entity Type | Individual
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Provider Name | ELIZABETH TICE MS BCBA LABA
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Gender | Female
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 20 ROCHE BROTHERS WAY STE 6-381
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City | NORTH EASTON
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State | MA
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Zip | 02356-1030
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Country | US
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Telephone | 855-832-6727
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Fax | 772-675-9100
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Provider Business Mailing Address
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Address Line | 656 MAYFLOWER ST
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City | DUXBURY
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State | MA
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Zip | 02332-3617
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Country | US
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Telephone | 973-768-4356
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1-13-14729
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 543
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License Number State | MA
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