Provider Demographics
NPI:1215273354
Name:WONG, TAMERA MADELINE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:MADELINE
Last Name:WONG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 N HELM AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1624
Mailing Address - Country:US
Mailing Address - Phone:559-930-7168
Mailing Address - Fax:
Practice Address - Street 1:126 S H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6821
Practice Address - Country:US
Practice Address - Phone:559-930-7168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-07-3326103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst