Provider Demographics
NPI:1356971345
Name:GENDREAU, LINDSAY (BCBA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:625 WOOD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-2424
Mailing Address - Country:US
Mailing Address - Phone:719-406-5855
Mailing Address - Fax:
Practice Address - Street 1:700 PLEASANT ST STE 130
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6254
Practice Address - Country:US
Practice Address - Phone:866-926-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst