Provider Demographics
NPI:1871247908
Name:ASCENCIO, TIA ANNETTE
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:ANNETTE
Last Name:ASCENCIO
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 1:87-176 MAIPALAOA RD # P36
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3294
Mailing Address - Country:US
Mailing Address - Phone:607-221-6221
Mailing Address - Fax:
Practice Address - Street 1:87-176 MAIPALAOA RD # P36
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3294
Practice Address - Country:US
Practice Address - Phone:909-868-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician