Individual
MRS. KELSEY ANN TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
9 HEARTHSTONE DR, KINNELON, NJ 07405-2303
(201) 259-2587
Mailing address
128 HAWTHORNE COURT, ROCKAWAY, NJ 07866
(201) 259-2587
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-24753
NJ
Other
Enumeration date
02/20/2017
Last updated
10/05/2018
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