Provider Demographics
NPI:1740619428
Name:GEORGE, CHRISTINE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 KNOX ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1332
Practice Address - Country:US
Practice Address - Phone:413-896-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-12687103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst