Provider Demographics
NPI:1497411730
Name:FREEDOM WINGS APPLIED BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:FREEDOM WINGS APPLIED BEHAVIORAL HEALTH
Other - Org Name:YUKI MAEDA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YUKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEDA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LABA
Authorized Official - Phone:603-321-5175
Mailing Address - Street 1:265 CHELMSFORD ST.
Mailing Address - Street 2:STE 7-1003
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2335
Mailing Address - Country:US
Mailing Address - Phone:603-321-5175
Mailing Address - Fax:978-418-1081
Practice Address - Street 1:265 CHELMSFORD ST.
Practice Address - Street 2:STE 7-1003
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2335
Practice Address - Country:US
Practice Address - Phone:603-321-5175
Practice Address - Fax:978-418-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1-1833220OtherBCBA
MA2620OtherLABA