Provider Demographics
NPI:1043637655
Name:INTEGRATED LEARNING ACADEMY NEWTON
Entity Type:Organization
Organization Name:INTEGRATED LEARNING ACADEMY NEWTON
Other - Org Name:APPLIED BEHAVIORAL LEARNING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS- IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY-D, BCBA
Authorized Official - Phone:617-916-5573
Mailing Address - Street 1:109 OAK ST
Mailing Address - Street 2:SUITE G10
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1492
Mailing Address - Country:US
Mailing Address - Phone:617-916-5573
Mailing Address - Fax:617-916-5081
Practice Address - Street 1:109 OAK ST
Practice Address - Street 2:SUITE G10
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-916-5573
Practice Address - Fax:617-916-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty