Provider Demographics
NPI:1679063705
Name:NEAL, HEATHER (BCBA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:PAMULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:6060 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1907
Mailing Address - Country:US
Mailing Address - Phone:317-584-5166
Mailing Address - Fax:317-815-3861
Practice Address - Street 1:145 ROSEMARY ST STE E
Practice Address - Street 2:
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494-3259
Practice Address - Country:US
Practice Address - Phone:978-737-3710
Practice Address - Fax:317-815-3861
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2312103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst