=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225417645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY C BARRON B.C.B.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2015
-----------------------------------------------------
Last Update Date | 07/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 REMINGTON ST
-----------------------------------------------------
City | EMERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07630-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-390-4643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 HERRING ST
-----------------------------------------------------
City | HARRINGTON PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07640-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-390-4643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------