Provider Demographics
NPI:1942949334
Name:WEBBE, TRISTAN KANE (BCBA, LABA)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:KANE
Last Name:WEBBE
Suffix:
Gender:M
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 1:2 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1459
Mailing Address - Country:US
Mailing Address - Phone:978-568-8800
Mailing Address - Fax:
Practice Address - Street 1:2 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-1459
Practice Address - Country:US
Practice Address - Phone:978-568-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2764103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst