Facts
- Status
- A
- Credential
- BCBA
- Type
- Individual
- Enumeration date
- 2016-11-29
- Last updated
- 2026-01-28
Specialties
Licenses
- License MA
- LABA3139
Location
- Practice location
- 105 HMS STAYNER DR
- City
- HINGHAM MA
- Postal code
- 020431664
- Phone
- 617-957-6451
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.