Provider Demographics
NPI:1568845972
Name:RICHARD, BRANDON ALAN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ALAN
Last Name:RICHARD
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 COMMON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2704
Mailing Address - Country:US
Mailing Address - Phone:617-276-5367
Mailing Address - Fax:
Practice Address - Street 1:124 WATERTOWN ST
Practice Address - Street 2:3H
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2576
Practice Address - Country:US
Practice Address - Phone:617-276-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst