Provider Demographics
NPI:1740530260
Name:FREDERICKS, PAULA J (EDD, BCBA-D, LABA)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:J
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:EDD, BCBA-D, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:103 MECHANIC ST # 484
Mailing Address - Street 2:
Mailing Address - City:EAST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01515-9800
Mailing Address - Country:US
Mailing Address - Phone:413-459-9565
Mailing Address - Fax:833-431-1244
Practice Address - Street 1:103 MECHANIC ST # 484
Practice Address - Street 2:
Practice Address - City:EAST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01515-9800
Practice Address - Country:US
Practice Address - Phone:413-459-9565
Practice Address - Fax:833-431-1244
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1295103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst