Provider Demographics
NPI:1285850271
Name:LUISELLI, JAMES KENNETH (EDD ABPP BCBA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:LUISELLI
Suffix:
Gender:M
Credentials:EDD ABPP BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PACELLA PARK DRIVE
Mailing Address - Street 2:MAY INSTITUTE
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:781-437-1205
Mailing Address - Fax:781-440-0401
Practice Address - Street 1:41 PACELLA PARK DRIVE
Practice Address - Street 2:MAY INSTITUTE
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-437-1205
Practice Address - Fax:781-440-0401
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical