MEDICARE: BROOKE ALYSE TRAYER BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1922871144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ALYSE TRAYER BCBA

Provider Business Mailing Address
First Line	:	542 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2163 OAK TREE RD STE 200
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-1084
Country	:	US
Telephone Number	:	877-880-2609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	12/01/2024

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