MEDICARE: MARISSA CHIZMADIA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-21-56349	NJ

General Provider Information

NPI Number	:	1023777893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA CHIZMADIA BCBA

Provider Business Mailing Address
First Line	:	716 MADISON ST APT 311
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6363
Country	:	US
Telephone Number	:	973-626-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 US HIGHWAY 46 W STE 302
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-3120
Country	:	US
Telephone Number	:	201-720-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/09/2021

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Directions to “ MARISSA CHIZMADIA BCBA” Practice Location

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