Provider Demographics
NPI:1336949650
Name:TYRRELL, ROBERT JR (BCBA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:TYRRELL
Suffix:JR
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4530
Mailing Address - Country:US
Mailing Address - Phone:215-901-0102
Mailing Address - Fax:
Practice Address - Street 1:528 W PINE ST
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4530
Practice Address - Country:US
Practice Address - Phone:215-901-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007624103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst