Provider Demographics
NPI:1730326042
Name:WALTON, DANA FENE (ED S, BCBA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:FENE
Last Name:WALTON
Suffix:
Gender:F
Credentials:ED S, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BOLTON WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1136
Mailing Address - Country:US
Mailing Address - Phone:978-317-0384
Mailing Address - Fax:508-762-9005
Practice Address - Street 1:59 BOLTON WOODS WAY
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1136
Practice Address - Country:US
Practice Address - Phone:978-317-0384
Practice Address - Fax:508-762-9005
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-08-4079103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst