Individual
DAJA BREANA TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, COBA
Contact information
Practice address
373 S WILLOW ST STE 266, MANCHESTER, NH 03103-5751
(877) 315-8080
Mailing address
373 S WILLOW ST STE 266, MANCHESTER, NH 03103-5751
(877) 315-8080
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-48756
OH
106S00000X
Behavior Technician
RBT-19-92121
OH
Other
Enumeration date
08/04/2020
Last updated
05/28/2026
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