Individual
MRS. BLUE WILLOW FAVREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
109 CHACE HILL RD, STERLING, MA 01564-1519
(978) 365-3891
Mailing address
109 CHACE HILL RD, STERLING, MA 01564-1519
(978) 365-3891
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-04-1792
MA
Other
Enumeration date
02/16/2012
Last updated
02/16/2012
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