Individual
TARA BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1776 AVENUE OF THE STATES STE 101A, LAKEWOOD, NJ 08701
(732) 730-0700
Mailing address
230 BRAEN AVE STE D, WYCKOFF, NJ 07481-2948
(973) 423-2254
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-28864
NY
Other
Enumeration date
03/08/2018
Last updated
06/21/2018
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