Provider Demographics
NPI:1386321370
Name:GROAK, TERESA DE JESUS (BCBA)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:DE JESUS
Last Name:GROAK
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 1:2300 S HACIENDA BLVD APT C8
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4632
Mailing Address - Country:US
Mailing Address - Phone:323-697-0299
Mailing Address - Fax:
Practice Address - Street 1:4401 CRENSHAW BLVD STE 115
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1227
Practice Address - Country:US
Practice Address - Phone:323-904-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst