| Aspire Learning Center Llc | |
|
100 Cummings Ctr Ste 135c Beverly MA 01915-6263 | |
| (978) 473-7300 | |
| (978) 969-0083 |
| Full Name | Aspire Learning Center Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 100 Cummings Ctr Ste 135c, Beverly, Massachusetts |
| Authorized Official Name and Position | Tiffaney Marie Frongillo (LICENSED APPLIED BEHAVIOR ANALYST) |
| Authorized Official Contact | 9783876563 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aspire Learning Center Llc 100 Cummings Ctr Ste 135c Beverly MA 01915-6263 Ph: (978) 473-7300 | Aspire Learning Center Llc 100 Cummings Ctr Ste 135c Beverly MA 01915-6263 Ph: (978) 473-7300 |
| NPI Number | 1912358813 |
|---|---|
| Provider Enumeration Date | 06/22/2016 |
| Last Update Date | 05/10/2022 |
| Certification Date | 05/10/2022 |
| Medicare PECOS PAC ID | 0941695522 |
|---|---|
| Medicare Enrollment ID | O20220407002465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912358813 | NPI | - | NPPES |
| 110118438A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 000000964 (Massachusetts) | Primary |
| 235Z00000X | Speech-language Pathologist | 8125 (Massachusetts) | Secondary |
| Provider Name | Jessica Dana Blutstein |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1700159449 PECOS PAC ID: 6406078765 Enrollment ID: I20141121000163 |
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