Provider Demographics
NPI:1548736267
Name:ADEEKO, TYRA
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:ADEEKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 DREXEL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2018
Mailing Address - Country:US
Mailing Address - Phone:413-218-5687
Mailing Address - Fax:
Practice Address - Street 1:38 DREXEL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2018
Practice Address - Country:US
Practice Address - Phone:413-218-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst