Provider Demographics
NPI:1568824076
Name:TAMAKLOE, IVY
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:TAMAKLOE
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 1:120 ELGAR PL
Mailing Address - Street 2:APT 14B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5103
Mailing Address - Country:US
Mailing Address - Phone:929-374-6362
Mailing Address - Fax:
Practice Address - Street 1:120 ELGAR PL
Practice Address - Street 2:APT 14B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5103
Practice Address - Country:US
Practice Address - Phone:929-374-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst