Provider Demographics
NPI:1235633140
Name:SUMMIT BEHAVIOR, LLC
Entity Type:Organization
Organization Name:SUMMIT BEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER AND SENIOR BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MARTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:508-380-6305
Mailing Address - Street 1:109 LANE DR
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 LANE DR
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3139
Practice Address - Country:US
Practice Address - Phone:508-380-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA428103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA330OtherLABA, BEHAVIOR ANALYST
MA449OtherLABA, BEHAVIOR ANALYST
MA428OtherLABA, BEHAVIOR ANALYST