Provider Demographics
NPI:1740027978
Name:MORENO, TATIANA MEGANN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:MEGANN
Last Name:MORENO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 HADDONFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3376
Mailing Address - Country:US
Mailing Address - Phone:856-406-0035
Mailing Address - Fax:856-406-0036
Practice Address - Street 1:4300 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3376
Practice Address - Country:US
Practice Address - Phone:856-406-0035
Practice Address - Fax:856-406-0036
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-73379103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst