Provider Demographics
NPI:1619482668
Name:BOSTON BEHAVIOR SERVICES EDUCATION AND TREATMENT
Entity Type:Organization
Organization Name:BOSTON BEHAVIOR SERVICES EDUCATION AND TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:COYLE
Authorized Official - Last Name:DEBRODER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LABA
Authorized Official - Phone:336-416-8266
Mailing Address - Street 1:62 SAINT ROSE ST # 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3956
Mailing Address - Country:US
Mailing Address - Phone:336-416-8266
Mailing Address - Fax:
Practice Address - Street 1:62 SAINT ROSE ST # 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3956
Practice Address - Country:US
Practice Address - Phone:336-416-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1910103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty