Individual
MR. CLINTON FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., BCBA, LABA
Contact information
Practice address
10 CONCORD AVE, CAMBRIDGE, MA 02138-2322
(781) 517-7554
Mailing address
14 ARCADIA ST, METHUEN, MA 01844-6508
(434) 327-8834
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
3123-MH-B1
MA
Other
Enumeration date
08/03/2020
Last updated
08/03/2020
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