Provider Demographics
NPI:1942811393
Name:GUAY, IVY JADE (MED BCBA)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:JADE
Last Name:GUAY
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 MONSON TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:PETERSHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01366-9611
Mailing Address - Country:US
Mailing Address - Phone:413-478-0149
Mailing Address - Fax:
Practice Address - Street 1:225 CEDAR HILL ST STE 200
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5900
Practice Address - Country:US
Practice Address - Phone:877-418-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA3313103K00000X
AK162599103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty