Provider Demographics
NPI:1871029553
Name:ENTWISTLE, KATHERINE MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:ENTWISTLE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BILLERICA RD
Mailing Address - Street 2:#4100
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:888-896-5227
Mailing Address - Fax:978-616-7863
Practice Address - Street 1:321 BILLERICA RD
Practice Address - Street 2:#4100
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824
Practice Address - Country:US
Practice Address - Phone:888-896-5227
Practice Address - Fax:978-616-7863
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst