Individual
TAVA TINA PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
705 CROSS ST, LAKEWOOD, NJ 08701-4029
(212) 481-4040
Mailing address
1231 S 9TH ST, SOUTH PLAINFIELD, NJ 07080-1603
(908) 397-5550
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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