Provider Demographics
NPI:1306651252
Name:GOODERMOTE, BRETT (BCBA)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:GOODERMOTE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:MA
Mailing Address - Zip Code:01256-9346
Mailing Address - Country:US
Mailing Address - Phone:413-652-8912
Mailing Address - Fax:
Practice Address - Street 1:167 LOOP RD
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:MA
Practice Address - Zip Code:01256-9346
Practice Address - Country:US
Practice Address - Phone:413-652-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA3868103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst