Provider Demographics
NPI:1235741356
Name:PROUD MOMENTS ABA OF TENNESSEE PLLC
Entity Type:Organization
Organization Name:PROUD MOMENTS ABA OF TENNESSEE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUIOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-215-5311
Mailing Address - Street 1:1449 37TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4381
Mailing Address - Country:US
Mailing Address - Phone:718-215-5311
Mailing Address - Fax:
Practice Address - Street 1:916 HOLGATE CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-6630
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty