Healthcare Provider Details

I. General information

NPI: 1154810497
Provider Name (Legal Business Name): TIFFANY JERONIMO MA, BCBA, LABA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 S MAIN ST STE 10
FALL RIVER MA
02721-5349
US

IV. Provider business mailing address

140 FAMILY DR
FALL RIVER MA
02721-2383
US

V. Phone/Fax

Practice location:
  • Phone: 800-679-3609
  • Fax:
Mailing address:
  • Phone: 508-558-6899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA4111
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: