Provider Demographics
NPI:1922870609
Name:DOUCETTE, SHANNON (MS BCBA LABA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:MS BCBA LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GAS LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2140
Mailing Address - Country:US
Mailing Address - Phone:781-258-6243
Mailing Address - Fax:
Practice Address - Street 1:123 GAS LIGHT DR
Practice Address - Street 2:APT 9
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-258-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10000458103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst