Provider Demographics
NPI:1457005886
Name:HATCH, DOUGLAS (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:HATCH
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 QUEEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1335
Mailing Address - Country:US
Mailing Address - Phone:321-890-7266
Mailing Address - Fax:
Practice Address - Street 1:76 SUMMER ST STE 139A
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5783
Practice Address - Country:US
Practice Address - Phone:978-602-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-56136103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst