Provider Demographics
NPI:1265157630
Name:WASHINGTON, TATYANA BRANDI-RAE (BCBA)
Entity type:Individual
Prefix:MS
First Name:TATYANA
Middle Name:BRANDI-RAE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
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Mailing Address - Street 1:18726 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3813
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:100 N. 18TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-853-6682
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst