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General NPI Number Information
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NPI Number | 1932517323
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Entity Type | Individual
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Provider Name | MYRNA BASSAM MS, BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 60 GRAND AVE STE 1
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6583
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Country | US
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Telephone | 201-849-4565
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Fax | 844-364-3239
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Provider Business Mailing Address
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Address Line | 60 GRAND AVE STE 1
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6583
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Country | US
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Telephone | 551-800-2441
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Fax | 844-364-3239
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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 | BCBA 1-1314553
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License Number State | CA
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