Provider Demographics
NPI:1891464632
Name:SHORTELL, MARY CATHERINE (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:SHORTELL
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TOPLIFF ST
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-6431
Mailing Address - Country:US
Mailing Address - Phone:781-454-6385
Mailing Address - Fax:
Practice Address - Street 1:11 TOPLIFF ST
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-6431
Practice Address - Country:US
Practice Address - Phone:781-454-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst