Provider Demographics
NPI:1821600271
Name:PEREZ, TARA (BCBA, TOH)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BCBA, TOH
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:VIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, TOH
Mailing Address - Street 1:329 AYCRIGG AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3713
Mailing Address - Country:US
Mailing Address - Phone:973-471-3046
Mailing Address - Fax:
Practice Address - Street 1:329 AYCRIGG AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3713
Practice Address - Country:US
Practice Address - Phone:973-471-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst