Provider Demographics
NPI:1477193605
Name:DE LA TORRE, YANNIET (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:YANNIET
Middle Name:
Last Name:DE LA TORRE
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 1:607 NORTH AVENUE
Mailing Address - Street 2:DOOR 11, FL 2
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1664
Mailing Address - Country:US
Mailing Address - Phone:866-926-4345
Mailing Address - Fax:
Practice Address - Street 1:607 NORTH AVENUE
Practice Address - Street 2:DOOR 11, FL 2
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1664
Practice Address - Country:US
Practice Address - Phone:866-926-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106S00000X
FL1-21-53788103K00000X
MA3817103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician