Provider Demographics
NPI:1962735472
Name:BOSTON ABA
Entity type:Organization
Organization Name:BOSTON ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ADLER
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:617-600-4862
Mailing Address - Street 1:124 WATERTOWN ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2500
Mailing Address - Country:US
Mailing Address - Phone:617-600-4862
Mailing Address - Fax:888-297-4712
Practice Address - Street 1:124 WATERTOWN ST STE 2E
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2500
Practice Address - Country:US
Practice Address - Phone:617-600-4862
Practice Address - Fax:888-297-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-07-3445251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health