Provider Demographics
NPI:1851003644
Name:SCOTT, NADJA TYRA (BCBA)
Entity Type:Individual
Prefix:
First Name:NADJA
Middle Name:TYRA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 LA SELVA ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2148
Mailing Address - Country:US
Mailing Address - Phone:650-232-4105
Mailing Address - Fax:650-332-2333
Practice Address - Street 1:3130 LA SELVA ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2148
Practice Address - Country:US
Practice Address - Phone:650-232-4105
Practice Address - Fax:650-332-2333
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12261792103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst