Provider Demographics
NPI:1003643081
Name:PASQUALE, SHANNON ELIZABETH (MS, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:PASQUALE
Suffix:
Gender:F
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELIZABETH
Other - Last Name:QUIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LABA
Mailing Address - Street 1:340 BERLIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-3919
Mailing Address - Country:US
Mailing Address - Phone:978-855-1358
Mailing Address - Fax:
Practice Address - Street 1:44 SCHOOL ST RM 325
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4209
Practice Address - Country:US
Practice Address - Phone:855-772-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10000635103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst