Provider Demographics
NPI:1326584129
Name:DENISCO, TIANA MARIA (BCBA)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:MARIA
Last Name:DENISCO
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 1:205 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1406
Mailing Address - Country:US
Mailing Address - Phone:781-761-5089
Mailing Address - Fax:
Practice Address - Street 1:205 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1406
Practice Address - Country:US
Practice Address - Phone:781-761-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2022-09-12
Deactivation Date:2019-10-17
Deactivation Code:
Reactivation Date:2019-10-28
Provider Licenses
StateLicense IDTaxonomies
106E00000X
1-19-37355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA042611055OtherTAX ID
MA1004745OtherFALLON
MAM18633OtherBCBS
MA1303287OtherMBHP