Provider Demographics
NPI:1780157776
Name:TEJEDA, YESSENIA
Entity type:Individual
Prefix:
First Name:YESSENIA
Middle Name:
Last Name:TEJEDA
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 1:3 BOWDOIN AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3901
Mailing Address - Country:US
Mailing Address - Phone:978-902-7595
Mailing Address - Fax:
Practice Address - Street 1:43 CHUBB RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7804
Practice Address - Country:US
Practice Address - Phone:508-596-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician