Provider Demographics
NPI:1962872051
Name:BARRUCH, ANDREA (MED BCBA LABA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BARRUCH
Suffix:
Gender:F
Credentials:MED BCBA LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 NEWBURY ST
Mailing Address - Street 2:STE 400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3042
Mailing Address - Country:US
Mailing Address - Phone:617-839-3707
Mailing Address - Fax:815-377-2574
Practice Address - Street 1:73 NEWBURY ST
Practice Address - Street 2:STE 400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3042
Practice Address - Country:US
Practice Address - Phone:617-839-3707
Practice Address - Fax:815-377-2574
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MA702103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst