Provider Demographics
NPI:1598222614
Name:BLAISDELL, STEPHEN (MSED, BCBA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BLAISDELL
Suffix:
Gender:M
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 DONALD LYNCH BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4702
Mailing Address - Country:US
Mailing Address - Phone:508-651-7500
Mailing Address - Fax:
Practice Address - Street 1:295 DONALD LYNCH BLVD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4702
Practice Address - Country:US
Practice Address - Phone:508-651-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst