Provider Demographics
NPI:1952652539
Name:SHERIDAN, ALESIA MARIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ALESIA
Middle Name:MARIE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:ALESIA
Other - Middle Name:
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 R WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1715
Mailing Address - Country:US
Mailing Address - Phone:781-923-0900
Mailing Address - Fax:781-773-1326
Practice Address - Street 1:45 R WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1715
Practice Address - Country:US
Practice Address - Phone:781-923-0900
Practice Address - Fax:781-773-1326
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
1-15-20148103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist