Provider Demographics
NPI:1710863865
Name:BARGE, BRENT ALAN (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALAN
Last Name:BARGE
Suffix:
Gender:M
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PERRY ST APT 18
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1555
Mailing Address - Country:US
Mailing Address - Phone:308-631-0401
Mailing Address - Fax:
Practice Address - Street 1:11 MIDSTATE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1881
Practice Address - Country:US
Practice Address - Phone:800-679-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10001714103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst