Provider Demographics
NPI:1376989996
Name:INTEGRATED LEARNING ACADEMY NEWTON
Entity Type:Organization
Organization Name:INTEGRATED LEARNING ACADEMY NEWTON
Other - Org Name:APPLIED BEHAVIORAL LEARNING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA-D
Authorized Official - Phone:617-467-4038
Mailing Address - Street 1:109 OAK ST STE G-10
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1492
Mailing Address - Country:US
Mailing Address - Phone:617-467-4523
Mailing Address - Fax:617-916-5081
Practice Address - Street 1:109 OAK ST STE G-10
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-467-4523
Practice Address - Fax:617-916-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty