Provider Demographics
NPI:1558834846
Name:ALBERTS, ELIZABETH MANCUSO (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MANCUSO
Last Name:ALBERTS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 GATES POND RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MA
Mailing Address - Zip Code:01503-1305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 GATES POND RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-1305
Practice Address - Country:US
Practice Address - Phone:978-562-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8322103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-11-8322OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD