Provider Demographics
NPI:1053688853
Name:BREWIN, ALFRED IV (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:BREWIN
Suffix:IV
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3703
Mailing Address - Country:US
Mailing Address - Phone:609-504-7134
Mailing Address - Fax:
Practice Address - Street 1:809 HERITAGE ROAD
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3703
Practice Address - Country:US
Practice Address - Phone:609-504-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst