Provider Demographics
NPI:1972805992
Name:POPPENGA, ANN PATRICIA (MSED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:PATRICIA
Last Name:POPPENGA
Suffix:
Gender:F
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:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-0256
Mailing Address - Country:US
Mailing Address - Phone:781-964-6366
Mailing Address - Fax:
Practice Address - Street 1:45 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1133
Practice Address - Country:US
Practice Address - Phone:781-964-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-03-1404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst