MEDICARE: MISS CLAIRE-MELISSA SUFFREN

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	15BC00103100	NJ

General Provider Information

NPI Number	:	1962132324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CLAIRE-MELISSA SUFFREN

Provider Business Mailing Address
First Line	:	48 PERSHING AVE
Second Line	:
City	:	ELIZABETH
State	:	NJ
Zip	:	07202-2246
Country	:	US
Telephone Number	:	908-764-7581
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 GALLOPING HILL RD STE 205
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-7980
Country	:	US
Telephone Number	:	908-345-2381
Fax Number	:

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	01/21/2026

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