Individual
WIDNA TAVERAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBA-NY
Contact information
Practice address
181 PINE TREE ROAD, MONROE, NY 10950
(646) 296-9221
Mailing address
181 PINE TREE RD, MONROE, NY 10950-3967
(646) 296-9221
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
002474-01
NY
235500000X
Speech/Language/Hearing Specialist/Technologist
Primary
175241
NY
Other
Enumeration date
06/12/2012
Last updated
09/24/2025
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