Provider Demographics
NPI:1932533734
Name:OLSON, MEREDITH MEGAN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:MEGAN
Last Name:OLSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:MEGAN
Other - Last Name:DORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:193 OAK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1453
Mailing Address - Country:US
Mailing Address - Phone:617-658-5611
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST STE G30
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-658-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA1-14-16797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist