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General NPI Number Information
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NPI Number | 1609250703
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Entity Type | Individual
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Provider Name | TATIANA PEAK
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Gender | Female
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 11 CARRIAGE WAY
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City | CINNAMINSON
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State | NJ
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Zip | 08077-3865
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Country | US
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Telephone | 609-351-6746
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 MOUNT HOLLY RD
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City | BURLINGTON
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State | NJ
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Zip | 08016-4722
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Country | US
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Telephone | 609-614-7495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1-15-18265
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License Number State | CO
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