Provider Demographics
NPI:1164978722
Name:BOSTON BEHAVIOR LEARNING CENTERS
Entity Type:Organization
Organization Name:BOSTON BEHAVIOR LEARNING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, BCBA-D
Authorized Official - Phone:617-467-4878
Mailing Address - Street 1:109 OAK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1492
Mailing Address - Country:US
Mailing Address - Phone:617-467-4878
Mailing Address - Fax:617-916-5081
Practice Address - Street 1:109 OAK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-467-4878
Practice Address - Fax:617-916-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7235103G00000X
MA583103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty