Provider Demographics
NPI:1588129092
Name:GAMBARDELLA, LIA TERESA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:TERESA
Last Name:GAMBARDELLA
Suffix:
Gender:F
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 1:8 CRANBERRY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2502
Mailing Address - Country:US
Mailing Address - Phone:401-477-4478
Mailing Address - Fax:
Practice Address - Street 1:33 PERRY AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2417
Practice Address - Country:US
Practice Address - Phone:508-455-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst