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NPI Code Detail

MEDICARE: TRINITY TEAGUE

MEDICARE: TRINITY TEAGUE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1235064379
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRINITY TEAGUE
Provider Business Mailing Address
First Line : 2550 N HOLLYWOOD WAY STE 301
Second Line :
City : BURBANK
State : CA
Zip : 91505-5025
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 207 AUTHORITY DR
Second Line :
City : FITCHBURG
State : MA
Zip : 01420-6044
Country : US
Telephone Number : 866-727-8274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2026
Last Update Date : 06/17/2026

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Directions to “ TRINITY TEAGUE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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