Provider Demographics
NPI:1518763739
Name:TEJADA, STAR ASIA
Entity type:Individual
Prefix:
First Name:STAR
Middle Name:ASIA
Last Name:TEJADA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3390
Mailing Address - Country:US
Mailing Address - Phone:603-688-3048
Mailing Address - Fax:
Practice Address - Street 1:250 CENTRE ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-3390
Practice Address - Country:US
Practice Address - Phone:603-688-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician