1205479029 NPI number — EMILY MARGARET O'BRIEN MS, BCBA, LABA

Table of content: EMILY MARGARET O'BRIEN MS, BCBA, LABA (NPI 1205479029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205479029 NPI number — EMILY MARGARET O'BRIEN MS, BCBA, LABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
EMILY
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, BCBA, LABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205479029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 ATKINS ST APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-881-6587
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RAC- REGIS COLLEGE CHILDREN'S CENTER ANGELA HALL
Provider Second Line Business Practice Location Address:
235 WELLESLEY STREET
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-768-7123
Provider Business Practice Location Address Fax Number:
781-768-7999
Provider Enumeration Date:
10/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-22-60296 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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