Provider Demographics
NPI:1104333616
Name:PALECHKA, GAIL DIANE (MS BCBA LABA)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:DIANE
Last Name:PALECHKA
Suffix:
Gender:F
Credentials:MS BCBA LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01070-9604
Mailing Address - Country:US
Mailing Address - Phone:269-598-4318
Mailing Address - Fax:
Practice Address - Street 1:129 N UNION ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:MA
Practice Address - Zip Code:01070-9604
Practice Address - Country:US
Practice Address - Phone:269-598-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst