Provider Demographics
NPI:1982460473
Name:TAVASCI, BRITTNEY MICHELLE
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:MICHELLE
Last Name:TAVASCI
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 1:22 STOREY AVE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7266
Mailing Address - Country:US
Mailing Address - Phone:505-388-5767
Mailing Address - Fax:
Practice Address - Street 1:22 STOREY AVE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-7266
Practice Address - Country:US
Practice Address - Phone:505-388-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician