Provider Demographics
NPI:1053795864
Name:TREJO, TARA (MS BCBA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:TREJO
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 DICKIE WAY
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2607
Mailing Address - Country:US
Mailing Address - Phone:305-304-5367
Mailing Address - Fax:
Practice Address - Street 1:6800 PARAGON PL STE 237
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1651
Practice Address - Country:US
Practice Address - Phone:540-283-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst