MEDICARE: BRITTANY NEUDECKER MS

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	10000283	MA

General Provider Information

NPI Number	:	1629561469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY NEUDECKER MS

Provider Business Mailing Address
First Line	:	20 WATERFALL DR APT B
Second Line	:
City	:	CANTON
State	:	MA
Zip	:	02021-4163
Country	:	US
Telephone Number	:	334-447-9160
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 CENTRE ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02130-5197
Country	:	US
Telephone Number	:	800-249-1266
Fax Number	:

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/21/2024

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