MEDICARE: ARIEL TETREAULT 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	1-15-18223	NH

General Provider Information

NPI Number	:	1407204902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL TETREAULT BCBA

Provider Business Mailing Address
First Line	:	149 BROAD ST
Second Line	:
City	:	HOLLIS
State	:	NH
Zip	:	03049-6028
Country	:	US
Telephone Number	:	603-860-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CUMMINGS CTR STE 135H
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-6127
Country	:	US
Telephone Number	:	978-927-0172
Fax Number	:	978-927-0179

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

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	08/28/2023

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