MEDICARE: GABRIELLE CHRISTINE CENTRA-TAYLOR 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	1-18-32054	NJ

General Provider Information

NPI Number	:	1124590344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE CHRISTINE CENTRA-TAYLOR BCBA

Provider Business Mailing Address
First Line	:	153 STANTON ST
Second Line	:
City	:	RAHWAY
State	:	NJ
Zip	:	07065-3121
Country	:	US
Telephone Number	:	732-439-1155
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	:	201-870-4467
Fax Number	:

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

Provider Enumeration Date	:	12/28/2018
Last Update Date	:	10/29/2021

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