Provider Demographics
NPI:1750753505
Name:GAUDREAU, CHELSEA ANNE (MA, BCBA, LABA)
Entity type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:ANNE
Last Name:GAUDREAU
Suffix:
Gender:F
Credentials:MA, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:232 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1844
Mailing Address - Country:US
Mailing Address - Phone:413-224-1261
Mailing Address - Fax:413-244-1078
Practice Address - Street 1:232 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1844
Practice Address - Country:US
Practice Address - Phone:413-224-1261
Practice Address - Fax:413-244-1078
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT662103K00000X
MA828103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst