Healthcare Provider Details

I. General information

NPI: 1811528532
Provider Name (Legal Business Name): GUIRLINE LEWIS MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GUIRLINE JENNIFER DERILUS

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 COMMERCE PKWY STE C
MOUNT LAUREL NJ
08054-2212
US

IV. Provider business mailing address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

V. Phone/Fax

Practice location:
  • Phone: 855-647-5888
  • Fax:
Mailing address:
  • Phone: 561-323-6593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11937424
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: