Healthcare Provider Details

I. General information

NPI: 1629776000
Provider Name (Legal Business Name): KIMBERLY LUCCHESI BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 RIVER AVE
LAKEWOOD NJ
08701-5659
US

IV. Provider business mailing address

34 HIGHLAND AVE
HAZLET NJ
07730-4042
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3723
  • Fax:
Mailing address:
  • Phone: 973-903-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63451
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: