Provider Demographics
NPI:1821303306
Name:DEMANCHE, JOHN J (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:DEMANCHE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 RICE RD
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-2096
Mailing Address - Country:US
Mailing Address - Phone:978-297-4301
Mailing Address - Fax:
Practice Address - Street 1:371 RICE RD
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-2096
Practice Address - Country:US
Practice Address - Phone:978-297-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2633103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst