Provider Demographics
NPI:1548778012
Name:HEBERT, AMY LYNN (BCBA, LABA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:HEBERT
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-3623
Mailing Address - Country:US
Mailing Address - Phone:508-465-0417
Mailing Address - Fax:508-465-0793
Practice Address - Street 1:11 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-3623
Practice Address - Country:US
Practice Address - Phone:508-465-0417
Practice Address - Fax:508-465-0793
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3120103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst