Provider Demographics
NPI:1780172783
Name:OLSON, CASSANDRA LEIGH (BCBA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEIGH
Last Name:OLSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CUSHING LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1603
Mailing Address - Country:US
Mailing Address - Phone:774-266-4068
Mailing Address - Fax:
Practice Address - Street 1:3 CUSHING LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1603
Practice Address - Country:US
Practice Address - Phone:774-266-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-18-29325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst