Provider Demographics
NPI:1558044016
Name:FERGUSON, ZACHARY THAYER (MS, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:THAYER
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ASNEBUMSKIT RD
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1350
Mailing Address - Country:US
Mailing Address - Phone:508-826-3205
Mailing Address - Fax:
Practice Address - Street 1:691 GRAFTON ST STE 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3185
Practice Address - Country:US
Practice Address - Phone:508-304-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst