Healthcare Provider Details

I. General information

NPI: 1700506342
Provider Name (Legal Business Name): SHIFRA SCHICK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 RUTGERS UNIVERSITY BLVD
LAKEWOOD NJ
08701-4537
US

IV. Provider business mailing address

203A RIDGE AVE
LAKEWOOD NJ
08701-3447
US

V. Phone/Fax

Practice location:
  • Phone: 732-554-2121
  • Fax: 732-554-1112
Mailing address:
  • Phone: 646-770-6730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60324
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: