Individual provider Active NPI

Tamerea Nicole Roberson, BCBA

  • Behavior Analyst
  • Martinez, GA
National Provider Identifier
1336717073
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-24-73205
Practice address
4115 Columbia Rd Ste 5
Martinez, GA 30907-0410
Phone
(855) 832-6724
NPI assigned
Jun 17, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-24-73205 Primary

Addresses

Primary practice location

4115 Columbia Rd Ste 5
Martinez, GA 30907-0410

Mailing address

7108 S Kanner Hwy
Stuart, FL 34997-7462
Phone (855) 832-6724

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://www.centralreach.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shawn Bohanan Behavioral Consultation, LLC CurrentSince Jun 1, 2021 Accepting new patients
Mumu Behavior Services Behavior Analyst Current Accepting new patients

Locations

1212 Augusta West Pkwy
Ste 1B
Augusta, GA 30909
Phone (706) 826-2770

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1336717073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7108 S KANNER HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349977462",
            "telephone_number": "855-832-6724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 COLUMBIA RD STE 5",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309070410",
            "telephone_number": "855-832-6724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "TAMEREA",
        "middle_name": "NICOLE",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-17",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-24-73205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.centralreach.com",
            "affiliation": "N",
            "address_1": "1212 Augusta West Pkwy Ste 1B",
            "city": "Augusta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "309091808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Martinez, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.