Provider Demographics
NPI:1568737211
Name:DEHERRERA, TERESA MARIA (BCBA, LBA)
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:MARIA
Last Name:DEHERRERA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 MIDLAND AVE APT B24
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1435
Mailing Address - Country:US
Mailing Address - Phone:917-842-4607
Mailing Address - Fax:
Practice Address - Street 1:1304 MIDLAND AVE APT B24
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1435
Practice Address - Country:US
Practice Address - Phone:917-842-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY776323174400000X
NY003306-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist