MEDICARE: CORRIEL HOLLAWAY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-86863	NJ

General Provider Information

NPI Number	:	1538028303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORRIEL HOLLAWAY BCBA

Provider Business Mailing Address
First Line	:	39 BURNET ST FL 2
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07102-2101
Country	:	US
Telephone Number	:	908-487-4342
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BROADACRES DR STE 175
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3165
Country	:	US
Telephone Number	:	201-720-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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