Gloria Leyla Fanning Tacoaman

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

LABA10000079 Issued in MA

Practice address

60 Concord St Ste 1
Wilmington, MA 01887-2179

Phone

(781) 694-8787

NPI assigned

Aug 4, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1053921114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 PACELLA PARK DR",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023681755",
            "telephone_number": "781-437-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 CONCORD ST STE 1",
            "city": "WILMINGTON",
            "state": "MA",
            "postal_code": "018872179",
            "telephone_number": "781-694-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING TACOAMAN",
        "first_name": "GLORIA",
        "middle_name": "LEYLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-04",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": "LABA10000079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026265E",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Secor, Licsw LLC
• Jamie Elliott, LPN, IBCLC
• Karen Elizabeth Enegess, M.A.
• Kayla Esce, LMHC
• Excella Homecare, Inc.
• Jennifer Lynn Faragi, M.A
• Jennifer Patricia Faretra, LISCW
• Caitlin Ferreira
• Linda G Fidrocki, PT
• Kristen Finlay

• Behavior Analyst in Wilmington, MA
• Providers in Wilmington, MA by specialty
• Behavior Analyst in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.