Provider Demographics
NPI:1114526738
Name:DUBOIS-WHITE, ANDRE LAURENCE (MSED, MS, BCBA/LABA)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:LAURENCE
Last Name:DUBOIS-WHITE
Suffix:
Gender:M
Credentials:MSED, MS, BCBA/LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3736
Mailing Address - Country:US
Mailing Address - Phone:413-733-6661
Mailing Address - Fax:413-732-7075
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1864
Practice Address - Country:US
Practice Address - Phone:413-747-0705
Practice Address - Fax:413-732-7075
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor