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NPI Code Detail

MEDICARE: TAMMY THOMAS LBCBA

MEDICARE: TAMMY THOMAS LBCBA
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
1103K00000XBehavior Analyst000502NY

General Provider Information

NPI Number : 1396142246
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY THOMAS LBCBA
Provider Business Mailing Address
First Line : 144 BOLTON RD
Second Line :
City : NEW HARTFORD
State : NY
Zip : 13413-2514
Country : US
Telephone Number : 315-272-7574
Fax Number :
Provider Business Practice Location Address
First Line : 19 ROBINSON RD
Second Line :
City : CLINTON
State : NY
Zip : 13323-1418
Country : US
Telephone Number : 315-853-6090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2014
Last Update Date : 11/20/2014

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Directions to “ TAMMY THOMAS LBCBA” Practice Location

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