Provider Demographics
NPI:1700699220
Name:MANTLE, NELSON (BCBA)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:MANTLE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROCKY LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1473
Mailing Address - Country:US
Mailing Address - Phone:617-455-2260
Mailing Address - Fax:
Practice Address - Street 1:23 CROSBY DR STE 300
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1423
Practice Address - Country:US
Practice Address - Phone:781-512-4591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst