Provider Demographics
NPI:1285058776
Name:PHELPS, DONNA (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 JUDY LN
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1271
Mailing Address - Country:US
Mailing Address - Phone:413-335-9030
Mailing Address - Fax:
Practice Address - Street 1:354 MERRIMACK ST STE 395
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1754
Practice Address - Country:US
Practice Address - Phone:774-206-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst