Provider Demographics
NPI:1639630049
Name:GAUDREAU, COURTNEY LEE (MA, BCBA, LABA)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LEE
Last Name:GAUDREAU
Suffix:
Gender:F
Credentials:MA, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BARLOWS LANDING RD STE 13
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559
Mailing Address - Country:US
Mailing Address - Phone:508-563-5767
Mailing Address - Fax:
Practice Address - Street 1:4 BARLOWS LANDING RD STE 13
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559
Practice Address - Country:US
Practice Address - Phone:508-563-5767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst