Healthcare Provider Details

I. General information

NPI: 1184544413
Provider Name (Legal Business Name): ANDREA J PAGAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 COMMERCE PKWY
MOUNT LAUREL NJ
08054-2233
US

IV. Provider business mailing address

1824 S PARK AVE
HADDON HEIGHTS NJ
08035-1141
US

V. Phone/Fax

Practice location:
  • Phone: 888-966-0746
  • Fax:
Mailing address:
  • Phone: 732-266-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-24-338105
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: