Provider Demographics
NPI:1427820489
Name:CALVARESE, TIFFANY (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CALVARESE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LEW DEWITT BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-1644
Mailing Address - Country:US
Mailing Address - Phone:540-949-7045
Mailing Address - Fax:
Practice Address - Street 1:520 LEW DEWITT BLVD STE 401
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-1644
Practice Address - Country:US
Practice Address - Phone:304-240-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003294103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst