Individual
MRS. SHAWNTEA NICOLE CRUDUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. BCBA
Contact information
Practice address
1 FEDERAL ST BLDG 101, SPRINGFIELD, MA 01105-1222
(603) 689-5825
Mailing address
48 MARY ST, CHICOPEE, MA 01020-1110
(413) 563-1432
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-33224
MA
Other
Enumeration date
12/23/2018
Last updated
12/23/2018
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