Provider Demographics
NPI:1053996421
Name:BORRAYO, TERESSA (BCBA)
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:
Last Name:BORRAYO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 MISSION BLVD SPC 93
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-6059
Mailing Address - Country:US
Mailing Address - Phone:626-922-7235
Mailing Address - Fax:
Practice Address - Street 1:4361 MISSION BLVD SPC 93
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-6059
Practice Address - Country:US
Practice Address - Phone:626-922-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-34240103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst