Provider Demographics
NPI:1962957472
Name:REARDON, ADAM (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:REARDON
Suffix:
Gender:M
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 157J
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6135
Mailing Address - Country:US
Mailing Address - Phone:978-969-2894
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 157J
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6135
Practice Address - Country:US
Practice Address - Phone:978-969-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA805103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst