Provider Demographics
NPI:1083928774
Name:CLARK, PAULETTE ELIZABETH (BCBA, LABA)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:ELIZABETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:
Other - Last Name:BURDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-2000
Mailing Address - Country:US
Mailing Address - Phone:508-386-0544
Mailing Address - Fax:
Practice Address - Street 1:90 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-2000
Practice Address - Country:US
Practice Address - Phone:508-386-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1010601103K00000X
MA000001448103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst