Healthcare Provider Details

I. General information

NPI: 1427820489
Provider Name (Legal Business Name): TIFFANY CALVARESE BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 LEW DEWITT BLVD STE 401
WAYNESBORO VA
22980-1644
US

IV. Provider business mailing address

520 LEW DEWITT BLVD STE 401
WAYNESBORO VA
22980-1644
US

V. Phone/Fax

Practice location:
  • Phone: 304-240-9093
  • Fax:
Mailing address:
  • Phone: 540-949-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003294
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: