Healthcare Provider Details

I. General information

NPI: 1275974834
Provider Name (Legal Business Name): SEAN DAVID TARRANT BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 KEONIANA ST APT 401
HONOLULU HI
96815-2022
US

IV. Provider business mailing address

456 KEONIANA ST APT 401
HONOLULU HI
96815-2022
US

V. Phone/Fax

Practice location:
  • Phone: 407-616-2345
  • Fax:
Mailing address:
  • Phone: 407-616-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-02-0519
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: