Provider Demographics
NPI:1205298932
Name:PRIDESTAR CENTER FOR APPLIED LEARNING
Entity type:Organization
Organization Name:PRIDESTAR CENTER FOR APPLIED LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA/LABA
Authorized Official - Phone:978-677-6952
Mailing Address - Street 1:229 STEDMAN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2705
Mailing Address - Country:US
Mailing Address - Phone:978-677-6952
Mailing Address - Fax:
Practice Address - Street 1:229 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2705
Practice Address - Country:US
Practice Address - Phone:978-677-6952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00123251S00000X, 385HR2060X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Single Specialty