Provider Demographics
NPI:1043839400
Name:NOVAKOWSKI, LAUREN (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:NOVAKOWSKI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BLOOMFIELD AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5777
Mailing Address - Country:US
Mailing Address - Phone:908-347-0123
Mailing Address - Fax:
Practice Address - Street 1:194 BLOOMFIELD AVE APT 102
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5777
Practice Address - Country:US
Practice Address - Phone:908-347-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBACB527236103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBACB527236OtherBACB