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General NPI Number Information
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NPI Number | 1144712159
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Entity Type | Individual
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Provider Name | MAKEBA MORRISON-BUISSERETH
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Gender | Female
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 272 DUNNS MILLS ROAD
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City | BORDENTOWN BORDENTOWN
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State | NJ
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Zip | 08505
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Country | US
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Telephone | 877-315-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 373 S WILLOW ST STE 266
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City | MANCHESTER
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State | NH
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Zip | 03103-5751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12259872
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License Number State | NJ
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