Provider Demographics
NPI:1124376835
Name:SYMMES, ALICE IRENE (MS ABA, BCBA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:IRENE
Last Name:SYMMES
Suffix:
Gender:F
Credentials:MS ABA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MENDON STREET
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747
Mailing Address - Country:US
Mailing Address - Phone:508-478-7335
Mailing Address - Fax:
Practice Address - Street 1:386 W MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2128
Practice Address - Country:US
Practice Address - Phone:855-222-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-04-1535103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst