Provider Demographics
NPI:1558621995
Name:SHADE-MONUTEAUX, DENA MICHELLE (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:MICHELLE
Last Name:SHADE-MONUTEAUX
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 FORTUNE BLVD
Mailing Address - Street 2:BEACON ABA SERVICES
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1750
Mailing Address - Country:US
Mailing Address - Phone:781-405-0111
Mailing Address - Fax:781-996-4974
Practice Address - Street 1:321 FORTUNE BLVD
Practice Address - Street 2:BEACON ABA SERVICES
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:781-405-0111
Practice Address - Fax:781-996-4974
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-10419103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst