Provider Demographics
NPI:1154881357
Name:RICHARDS-ROBERTS, TANESHA TERRI-ANN
Entity type:Individual
Prefix:MRS
First Name:TANESHA
Middle Name:TERRI-ANN
Last Name:RICHARDS-ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S 2ND AVE APT B22
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3419
Mailing Address - Country:US
Mailing Address - Phone:914-513-4362
Mailing Address - Fax:
Practice Address - Street 1:466 MAIN ST # LL20
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6431
Practice Address - Country:US
Practice Address - Phone:646-666-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician