Provider Demographics
NPI:1780382960
Name:GAMBLE, ELISE D (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:D
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 INGALLS TER
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2210
Mailing Address - Country:US
Mailing Address - Phone:978-882-3796
Mailing Address - Fax:
Practice Address - Street 1:2 INGALLS TER
Practice Address - Street 2:
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-2210
Practice Address - Country:US
Practice Address - Phone:978-882-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-33852103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2257OtherLICENSE APPLIED BEHAVIOR ANALYST
1-18-33852OtherBEHAVIOR ANALYST CERTIFICATION BOARD