Mary K Champagne

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

LABA100000563 Issued in MA

Practice address

109 Oak St Ste G30
Newton, MA 02464-1492

Phone

(518) 578-6483

NPI assigned

Jun 23, 2021

Last updated

Mar 23, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742688000000",
    "number": "1568031417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 CHARLES ST",
            "city": "AUBURNDALE",
            "state": "MA",
            "postal_code": "024661709",
            "telephone_number": "518-578-6483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 OAK ST STE G30",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024641492",
            "telephone_number": "518-578-6483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPAGNE",
        "first_name": "MARY",
        "middle_name": "K",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-23",
        "last_updated": "2025-03-23",
        "certification_date": "2025-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": "100000563",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": "LABA100000563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen B Chafkin, DMD
• Katherine Chahal, PAC
• Sari Robyn Chait, PH.D.
• Chereen Zakieh Chalak, MSN, APRN, FNP-BC
• Kemely Champagne
• Alison Nicole Chan, B.S.
• Joan Chan
• Samantha Chan
• Matthew Chance
• Stephanie Chancey, M.A., R-DMT

• Behavior Analyst in Newton, MA
• Providers in Newton, MA by specialty
• Behavior Analyst in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.