Provider Demographics
NPI:1033884861
Name:TREJO, TERESA M (BCBA 1-25-79473)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:TREJO
Suffix:
Gender:
Credentials:BCBA 1-25-79473
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 LORAINE AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-3044
Mailing Address - Country:US
Mailing Address - Phone:954-665-9457
Mailing Address - Fax:239-424-8055
Practice Address - Street 1:1604 LORAINE AVE S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-3044
Practice Address - Country:US
Practice Address - Phone:954-665-9457
Practice Address - Fax:239-424-8055
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-156167106S00000X
FL12579473103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician