Provider Demographics
NPI:1902100472
Name:TUBBS, BRENDAN (BCBA, LABA, LBA)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:
Last Name:TUBBS
Suffix:
Gender:M
Credentials:BCBA, LABA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ERVING
Mailing Address - State:MA
Mailing Address - Zip Code:01344-4403
Mailing Address - Country:US
Mailing Address - Phone:413-422-1227
Mailing Address - Fax:
Practice Address - Street 1:1 RIVER ST
Practice Address - Street 2:
Practice Address - City:ERVING
Practice Address - State:MA
Practice Address - Zip Code:01344-4403
Practice Address - Country:US
Practice Address - Phone:413-422-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA795103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst