Provider Demographics
NPI:1124534276
Name:DIMMICK, LAURA SILVERMAN (BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SILVERMAN
Last Name:DIMMICK
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 1:10 RUTLEDGE ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4588
Mailing Address - Country:US
Mailing Address - Phone:518-810-2435
Mailing Address - Fax:
Practice Address - Street 1:207 MAIN ST STE 308
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3850
Practice Address - Country:US
Practice Address - Phone:508-485-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-28209103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst