Individual
TI'ARA T PENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1591 BRUCKNER BLVD APT 14H, BRONX, NY 10472-6431
(347) 987-5320
Mailing address
1591 BRUCKNER BLVD APT 14H, BRONX, NY 10472-6431
(347) 987-5320
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
106S000000X
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
932397413
GHI
NY
Enumeration date
01/24/2019
Last updated
01/24/2019
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