Provider Demographics
NPI:1477207157
Name:MCDONOUGH, ABIGAIL (MS, BCBA, LBA, LABA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:MS, BCBA, LBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ATWOOD AVE STE 1034
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4130
Mailing Address - Country:US
Mailing Address - Phone:401-310-2220
Mailing Address - Fax:
Practice Address - Street 1:148 ATWOOD AVE STE 1034
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4130
Practice Address - Country:US
Practice Address - Phone:401-310-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
RILBA00414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician