=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992615959
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA MANZANILLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2026
-----------------------------------------------------
Last Update Date | 09/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 W CENTURY RD STE 150
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-979-1336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 BELGROVE DR
-----------------------------------------------------
City | KEARNY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07032-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-25-86481
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------