MEDICARE: ADAM REARDON MSED, 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	805	MA

General Provider Information

NPI Number	:	1962957472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM REARDON MSED, BCBA

Provider Business Mailing Address
First Line	:	100 CUMMINGS CTR STE 157J
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-6135
Country	:	US
Telephone Number	:	978-969-2894
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CUMMINGS CTR STE 157J
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-6135
Country	:	US
Telephone Number	:	978-969-2894
Fax Number	:

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

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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