MEDICARE: ASHLEY MARIE BRENNAN BCABA

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	106E00000X	Assistant Behavior Analyst	0-25-16671	NJ

General Provider Information

NPI Number	:	1700745478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MARIE BRENNAN BCABA

Provider Business Mailing Address
First Line	:	503 HOPE CHAPEL RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1559
Country	:	US
Telephone Number	:	732-353-1616
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 HOPE CHAPEL RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1559
Country	:	US
Telephone Number	:	732-353-1616
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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