Provider Demographics
NPI:1255689634
Name:TAGOE, NAA AMELEY (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NAA AMELEY
Middle Name:
Last Name:TAGOE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MRS
Other - First Name:NAA AMELEY
Other - Middle Name:
Other - Last Name:TAGOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:9815 HALDEMAN AVE
Mailing Address - Street 2:A301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2250
Mailing Address - Country:US
Mailing Address - Phone:856-952-0661
Mailing Address - Fax:
Practice Address - Street 1:3002 LINCOLN DRIVE WEST
Practice Address - Street 2:SUITE E
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-952-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11211451103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst