Provider Demographics
NPI:1932443439
Name:TODISCO, GREGORY J (LMHC, BCBA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:TODISCO
Suffix:
Gender:M
Credentials:LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CABOT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1158
Mailing Address - Country:US
Mailing Address - Phone:508-618-1329
Mailing Address - Fax:508-618-1334
Practice Address - Street 1:20 CABOT BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1158
Practice Address - Country:US
Practice Address - Phone:978-835-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8198101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst