Provider Demographics
NPI:1073892410
Name:TAYLOR, TERESA HERRERO II (PHD BCBA-D)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:HERRERO
Last Name:TAYLOR
Suffix:II
Gender:F
Credentials:PHD BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11284 THURSTON CHASE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9366
Mailing Address - Country:US
Mailing Address - Phone:609-721-1428
Mailing Address - Fax:
Practice Address - Street 1:11284 THURSTON CHASE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9366
Practice Address - Country:US
Practice Address - Phone:609-721-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4755103K00000X
103T00000X
NJ35SI00517200103T00000X
FLPY6890103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst