1689236820 NPI number — AMELIA BEATRICE ANDREWS BCBA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689236820 NPI number — AMELIA BEATRICE ANDREWS BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
AMELIA
Provider Middle Name:
BEATRICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESJARDINS
Provider Other First Name:
AMELIA
Provider Other Middle Name:
BEATRICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689236820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/27/2021
NPI Reactivation Date:
05/18/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERVING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01344-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-776-4422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERVING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01344-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-776-4422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2019

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: 1-21-49462 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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