Provider Demographics
NPI:1548618960
Name:MATSON-DURKIN, HOLLY CHRISTINE (BCBA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CHRISTINE
Last Name:MATSON-DURKIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EAST ST
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1836
Mailing Address - Country:US
Mailing Address - Phone:978-314-8627
Mailing Address - Fax:
Practice Address - Street 1:7 EAST ST
Practice Address - Street 2:
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1836
Practice Address - Country:US
Practice Address - Phone:978-314-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-17472103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst