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General NPI Number Information
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NPI Number | 1235741356
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Entity Type | Organization
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Legal Business Name | PROUD MOMENTS ABA OF TENNESSEE PLLC
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 916 HOLGATE CT
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City | NASHVILLE
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State | TN
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Zip | 37221-6630
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Country | US
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Telephone | 718-215-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 1449 37TH ST STE 100
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City | BROOKLYN
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State | NY
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Zip | 11218-4381
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Country | US
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Telephone | 718-215-5311
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Fax |
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Authorized Official
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Title or Position | COO
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Name | PATTY BUIOCCHI
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Credential |
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Telephone | 718-215-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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