Provider Demographics
NPI:1386010700
Name:WEIMAR, ASHLEY NICOLE (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:WEIMAR
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 TREMONT ST
Mailing Address - Street 2:APT E214
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1052
Mailing Address - Country:US
Mailing Address - Phone:631-793-2383
Mailing Address - Fax:
Practice Address - Street 1:791 TREMONT ST
Practice Address - Street 2:APT E214
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1052
Practice Address - Country:US
Practice Address - Phone:631-793-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-11919103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst