Provider Demographics
NPI:1720548548
Name:VIDOSEVIC, TANIA ANN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:ANN
Last Name:VIDOSEVIC
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:ANN
Other - Last Name:VUKUSIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:339 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3560
Mailing Address - Country:US
Mailing Address - Phone:203-671-1118
Mailing Address - Fax:
Practice Address - Street 1:339 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3560
Practice Address - Country:US
Practice Address - Phone:203-671-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001260-1103K00000X
CT273103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst