Provider Demographics
NPI:1033808399
Name:MARK, RIVKAH (MS BCBA)
Entity Type:Individual
Prefix:
First Name:RIVKAH
Middle Name:
Last Name:MARK
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NUSSBAUM AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4677
Mailing Address - Country:US
Mailing Address - Phone:347-798-7831
Mailing Address - Fax:
Practice Address - Street 1:24 NUSSBAUM AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4677
Practice Address - Country:US
Practice Address - Phone:347-798-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-57003103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst