Provider Demographics
NPI:1205509528
Name:ROGOWSKI, ALLISON (BCBA, LABA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ROGOWSKI
Suffix:
Gender:F
Credentials:BCBA, LABA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 FARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-9754
Mailing Address - Country:US
Mailing Address - Phone:518-534-2995
Mailing Address - Fax:
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:978-538-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-16-23138103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst