MEDICARE: AUDREY E CONCANNON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1194669960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY E CONCANNON

Provider Business Mailing Address
First Line	:	109 OAK ST STE G20
Second Line	:
City	:	NEWTON UPPER FALLS
State	:	MA
Zip	:	02464-1492
Country	:	US
Telephone Number	:	617-658-5611
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 COPELAND ST FL 4
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-4082
Country	:	US
Telephone Number	:	617-658-5611
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ AUDREY E CONCANNON ” Practice Location

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