Provider Demographics
NPI:1689262867
Name:BRAWLEY, SAMANTHA FAY (MA, BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:FAY
Last Name:BRAWLEY
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 1:51 JENNESS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1629
Mailing Address - Country:US
Mailing Address - Phone:617-828-8184
Mailing Address - Fax:
Practice Address - Street 1:51 JENNESS ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1629
Practice Address - Country:US
Practice Address - Phone:617-828-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3311103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst