MEDICARE: MS. SUSAN M MASELLI BCBA, LABA

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	1-05-2334	MA

General Provider Information

NPI Number	:	1386520849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN M MASELLI BCBA, LABA

Provider Business Mailing Address
First Line	:	304 SOUTH ST
Second Line	:
City	:	FOXBORO
State	:	MA
Zip	:	02035-2750
Country	:	US
Telephone Number	:	978-590-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 ROCHE BROTHERS WAY
Second Line	:	SUITE 6-381
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1030
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	12/06/2025

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