Provider Demographics
NPI:1427488683
Name:JADRO, BRIAN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:JADRO
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3228
Mailing Address - Country:US
Mailing Address - Phone:908-296-5611
Mailing Address - Fax:
Practice Address - Street 1:303 WYMAN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1208
Practice Address - Country:US
Practice Address - Phone:781-548-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MA315103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst