Provider Demographics
NPI:1104123025
Name:BLANCHETTE, MARYBETH (BCBA)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:BLANCHETTE
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 1:201 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1024
Mailing Address - Country:US
Mailing Address - Phone:401-301-0108
Mailing Address - Fax:508-336-3782
Practice Address - Street 1:2348 POST RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2258
Practice Address - Country:US
Practice Address - Phone:401-681-4637
Practice Address - Fax:401-681-4675
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst