Provider Demographics
NPI:1649567124
Name:WILSON BISHOP, GINETTE (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:
Last Name:WILSON BISHOP
Suffix:
Gender:F
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 1:85 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4411
Mailing Address - Country:US
Mailing Address - Phone:617-923-7575
Mailing Address - Fax:617-663-6252
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4411
Practice Address - Country:US
Practice Address - Phone:617-923-7575
Practice Address - Fax:617-663-6252
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst