Provider Demographics
NPI:1407667389
Name:TAVAREZ, DILENY M
Entity type:Individual
Prefix:
First Name:DILENY
Middle Name:M
Last Name:TAVAREZ
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 1:219 NEW BRUNSWICK AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4122
Mailing Address - Country:US
Mailing Address - Phone:848-242-6903
Mailing Address - Fax:
Practice Address - Street 1:219 NEW BRUNSWICK AVE APT 8
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4122
Practice Address - Country:US
Practice Address - Phone:848-242-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician