Individual
ALEX THANH THACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
39 BRIGHTON AVE STE 100, ALLSTON, MA 02134-2301
(617) 402-5444
Mailing address
50 BROCK ST APT 1, BRIGHTON, MA 02135-2795
(617) 402-5444
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LABA10001944
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000023532
BMC
MA
01
—
042611055
TAX ID
MA
01
—
1004745
FALLON
MA
01
—
1303287
MBHP
MA
01
—
99618201
NETWORK HEALTH
MA
01
—
M18633
BCBS
MA
Enumeration date
08/10/2020
Last updated
12/16/2025
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