Provider Demographics
NPI:1679467872
Name:TIRADO, KAYA
Entity type:Individual
Prefix:
First Name:KAYA
Middle Name:
Last Name:TIRADO
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 KINGSLEY DR APT D2
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1227
Mailing Address - Country:US
Mailing Address - Phone:860-797-8095
Mailing Address - Fax:
Practice Address - Street 1:34 KINGSLEY DR APT D2
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:CT
Practice Address - Zip Code:06232-1227
Practice Address - Country:US
Practice Address - Phone:860-797-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician