Provider Demographics
NPI:1992254098
Name:IANNOTTA-BIESZCZAD, TRISHA IDA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:IDA
Last Name:IANNOTTA-BIESZCZAD
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 1:1350 HILLRISE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4759
Mailing Address - Country:US
Mailing Address - Phone:575-288-1881
Mailing Address - Fax:575-288-1889
Practice Address - Street 1:1350 HILLRISE CIR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4759
Practice Address - Country:US
Practice Address - Phone:575-288-1881
Practice Address - Fax:575-288-1889
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-16-23620103K00000X
NMBCBA-1-16-23620103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst