Provider Demographics
NPI:1487916409
Name:SCOTT, TANYA RAE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:RAE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:RAE
Other - Last Name:YAMIOLKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1942 EMBARCADERO
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5213
Mailing Address - Country:US
Mailing Address - Phone:510-832-4383
Mailing Address - Fax:510-550-1981
Practice Address - Street 1:1942 EMBARCADERO
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5213
Practice Address - Country:US
Practice Address - Phone:510-832-4383
Practice Address - Fax:510-550-1981
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst