MEDICARE: MS. TIFFANY M REID 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	103TB0200X	Cognitive & Behavioral Psychologist	1-06-3055	NJ
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist	1-06-3055	NJ

General Provider Information

NPI Number	:	1285890665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY M REID BCBA

Provider Business Mailing Address
First Line	:	400 CRANBURY RD
Second Line	:	APT.4
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3661
Country	:	US
Telephone Number	:	732-770-6763
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CRANBURY RD
Second Line	:	APT.4
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3661
Country	:	US
Telephone Number	:	732-770-6763
Fax Number	:

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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