Provider Demographics
NPI:1407237290
Name:KLEIN, TARA (BCBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:KLEIN
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:PO BOX 8071
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08650-0071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 WILDFLOWER CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1973
Practice Address - Country:US
Practice Address - Phone:609-843-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst