MEDICARE: TARA TREJO-JAMISON M.S. BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0133002610	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053795864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA TREJO-JAMISON M.S. BCBA

Provider Business Mailing Address
First Line	:	158 DICKIE WAY
Second Line	:
City	:	TAVERNIER
State	:	FL
Zip	:	33070-2607
Country	:	US
Telephone Number	:	305-304-5367
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 COMMONWEALTH PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4517
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	05/05/2026

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