Provider Demographics
NPI:1134679830
Name:BRADLEY, TASHA (BCBA)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:BRADLEY
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 1:37 TALCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2094
Mailing Address - Country:US
Mailing Address - Phone:802-662-7831
Mailing Address - Fax:802-662-7834
Practice Address - Street 1:37 TALCOTT RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2094
Practice Address - Country:US
Practice Address - Phone:802-662-7831
Practice Address - Fax:802-662-7834
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1-16-23018OtherBEHAVIORAL ANALYST CERTIFICATION BOARD