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1174062335 NPI number — KELSEY ANN TAVARES BCBA

NPI Number: 1174062335
Health Care Provider/Practitioner: KELSEY ANN TAVARES BCBA

Information about “1174062335” NPI (KELSEY ANN TAVARES BCBA) exists in 1174062335 in HTML format HTML  |  1174062335 in plain Text format TXT  |  1174062335 in PDF (Portable Document Format) PDF  |  1174062335 in an XML format XML  formats.

NPI Number : 1174062335 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174062335",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TAVARES",
    "FirstName": "KELSEY",
    "MiddleName": "ANN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "BCBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCCABE",
    "OtherFirstName": "KELSEY",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "BCBA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "128 HAWTHORNE COURT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROCKAWAY",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07866",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "201-259-2587",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9 HEARTHSTONE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KINNELON",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07405-2303",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "201-259-2587",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/20/2017",
    "LastUpdateDate": "10/05/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103K00000X",
        "TaxonomyName": "Behavior Analyst",
        "LicenseNumber": "1-16-24753",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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