Healthcare Provider Details

I. General information

NPI: 1083249791
Provider Name (Legal Business Name): VICTORIA EDWARDS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SHORE RD
LINWOOD NJ
08221-2349
US

IV. Provider business mailing address

6142 OAK ST
MAYS LANDING NJ
08330-3750
US

V. Phone/Fax

Practice location:
  • Phone: 609-970-5792
  • Fax:
Mailing address:
  • Phone: 609-970-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47795
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-114418
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: