Provider Demographics
NPI:1649793415
Name:TAMTON, ELIZABETH (MS, BCBA, NCSP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TAMTON
Suffix:
Gender:F
Credentials:MS, BCBA, NCSP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:RAYNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 WELLINGTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3006
Mailing Address - Country:US
Mailing Address - Phone:585-802-9644
Mailing Address - Fax:
Practice Address - Street 1:124 WATERTOWN ST STE 3H
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2576
Practice Address - Country:US
Practice Address - Phone:617-272-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000001930103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst