Healthcare Provider Details

I. General information

NPI: 1699692467
Provider Name (Legal Business Name): CASSIDY ALIA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RARITAN AVE
HIGHLAND PARK NJ
08904-2740
US

IV. Provider business mailing address

28 PINEHURST RD
BRICK NJ
08723-5451
US

V. Phone/Fax

Practice location:
  • Phone: 732-845-6602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00376600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: