Provider Demographics
NPI:1477978104
Name:BALA, ELIZABETH HOOPER (MED, BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HOOPER
Last Name:BALA
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ANN LEE RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1217
Mailing Address - Country:US
Mailing Address - Phone:978-391-1248
Mailing Address - Fax:
Practice Address - Street 1:55 ANN LEE RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1217
Practice Address - Country:US
Practice Address - Phone:978-391-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-12-11457103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst