Provider Demographics
NPI:1720504657
Name:VACHON, NAOMI MARIE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:MARIE
Last Name:VACHON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:MARIE
Other - Last Name:FRANCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:457 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-1668
Mailing Address - Country:US
Mailing Address - Phone:781-792-0064
Mailing Address - Fax:
Practice Address - Street 1:1115 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7501
Practice Address - Country:US
Practice Address - Phone:508-521-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1437103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst