Provider Demographics
NPI:1508656307
Name:TOMLINSON, IMAJAE MONIQUE
Entity type:Individual
Prefix:
First Name:IMAJAE
Middle Name:MONIQUE
Last Name:TOMLINSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 N BROAD ST APT E8
Practice Address - Street 2:
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069-3005
Practice Address - Country:US
Practice Address - Phone:856-839-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician