Provider Demographics
NPI:1619461613
Name:FARNSWORTH, THOMAS (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:FARNSWORTH
Suffix:
Gender:M
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1403
Mailing Address - Country:US
Mailing Address - Phone:203-815-7324
Mailing Address - Fax:
Practice Address - Street 1:266 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1403
Practice Address - Country:US
Practice Address - Phone:203-815-7324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2225103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst