Provider Demographics
NPI:1578176582
Name:LAROSA, UYEN TRAN TAN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:UYEN
Middle Name:TRAN TAN
Last Name:LAROSA
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 1:542 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1016
Mailing Address - Country:US
Mailing Address - Phone:857-701-2003
Mailing Address - Fax:
Practice Address - Street 1:639 GRANITE ST STE 230
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5366
Practice Address - Country:US
Practice Address - Phone:561-323-6593
Practice Address - Fax:561-997-1246
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARBT-22-248581106S00000X
MA1-24-75453103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician