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Individual

MRS. TARA KERVICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA

Contact information

Practice address
205 BURLINGTON RD, BEDFORD, MA 01730-1406
(781) 862-3600
Mailing address
227 CHELMSFORD ST, CHELMSFORD, MA 01824-2305
(978) 732-7171

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
3467-MH-B1
MA
106S00000X
Behavior Technician
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000023532
BMC
MA
01
042611055
TAX ID
MA
01
1004745
NHP
MA
01
1303287
MBHP
MA
01
99618201
NETWORK HEALTH
MA
01
M18633
BCBS
MA
Enumeration date
04/05/2017
Last updated
12/17/2021
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