Provider Demographics
NPI:1245576586
Name:NORTHEAST APPLIED BEHAVIOR ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTHEAST APPLIED BEHAVIOR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, EDS, BCBA-D
Authorized Official - Phone:774-573-0291
Mailing Address - Street 1:15 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3709
Mailing Address - Country:US
Mailing Address - Phone:774-573-0291
Mailing Address - Fax:
Practice Address - Street 1:15 LANTERN LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3709
Practice Address - Country:US
Practice Address - Phone:774-573-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-04-1999251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health