Provider Demographics
NPI:1558969360
Name:LEBOEUF, JUSTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:LEBOEUF
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GREENLEAF ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2514
Mailing Address - Country:US
Mailing Address - Phone:978-888-4059
Mailing Address - Fax:
Practice Address - Street 1:15 GROTON ST
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463-1519
Practice Address - Country:US
Practice Address - Phone:978-732-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3248-MH-B1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst