Provider Demographics
NPI:1386270569
Name:BRONSTEIN, TAMMY (BCBA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BRONSTEIN
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 1:367 ORANGE ST APT 414
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6478
Mailing Address - Country:US
Mailing Address - Phone:678-313-9233
Mailing Address - Fax:
Practice Address - Street 1:90 CANAL ST STE 400
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2022
Practice Address - Country:US
Practice Address - Phone:857-285-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-54138103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst