Provider Demographics
NPI:1205719499
Name:ROGER AND JESSY TNM LLC
Entity type:Organization
Organization Name:ROGER AND JESSY TNM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTER MARET
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:310-920-8544
Mailing Address - Street 1:275 GROVER ST
Mailing Address - Street 2:STE 2400
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1452
Mailing Address - Country:US
Mailing Address - Phone:310-920-8544
Mailing Address - Fax:
Practice Address - Street 1:275 GROVER ST
Practice Address - Street 2:STE 2400
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02466-1452
Practice Address - Country:US
Practice Address - Phone:310-920-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty