Provider Demographics
NPI:1871029553
Name:ENTWISTLE, KATHERINE (BCBA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ENTWISTLE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 GREENMONT AVE APT 56
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3806
Mailing Address - Country:US
Mailing Address - Phone:401-742-2816
Mailing Address - Fax:
Practice Address - Street 1:102 PERIMETER RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1301
Practice Address - Country:US
Practice Address - Phone:800-778-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4146103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst