MEDICARE: JEAN NEBLE

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

General Provider Information

NPI Number	:	1376074542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN NEBLE

Provider Business Mailing Address
First Line	:	PO BOX 3033
Second Line	:
City	:	OAK BLUFFS
State	:	MA
Zip	:	02557-3033
Country	:	US
Telephone Number	:	978-337-2715
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PINEWOOD LANE
Second Line	:
City	:	OAK BLUFFS
State	:	MA
Zip	:	02557-3033
Country	:	US
Telephone Number	:	978-337-2715
Fax Number	:

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

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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Directions to “ JEAN NEBLE ” Practice Location

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