Provider Demographics
NPI:1023524071
Name:BEATON, SANDRA M (MS, BCBA, LABA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:M
Last Name:BEATON
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 1:78 QUEENS BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-3127
Mailing Address - Country:US
Mailing Address - Phone:617-688-4074
Mailing Address - Fax:
Practice Address - Street 1:78 QUEENS BROOK RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-3127
Practice Address - Country:US
Practice Address - Phone:617-688-4074
Practice Address - Fax:617-688-4074
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA683103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst