MEDICARE: MRS. COLLEEN ANNE GONSALVES BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	LABA10000165	MA
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1184081895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN ANNE GONSALVES BCBA

Provider Business Mailing Address
First Line	:	542 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	542 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:	844-771-0965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	03/04/2025

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