Provider Demographics
NPI:1063968220
Name:HENDERSHOTT, ANDREA RAFFERTY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RAFFERTY
Last Name:HENDERSHOTT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-2612
Mailing Address - Country:US
Mailing Address - Phone:508-441-1381
Mailing Address - Fax:
Practice Address - Street 1:283 PINE ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-2612
Practice Address - Country:US
Practice Address - Phone:508-441-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1004103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst