Provider Demographics
NPI:1033661947
Name:LOSHUSAN, MARINA (BCBA, LABA)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:LOSHUSAN
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1418
Mailing Address - Country:US
Mailing Address - Phone:508-266-7077
Mailing Address - Fax:508-266-7107
Practice Address - Street 1:214 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1418
Practice Address - Country:US
Practice Address - Phone:508-266-7077
Practice Address - Fax:508-266-7107
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-16-23781103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst