Provider Demographics
NPI:1063032647
Name:FOJUT, KIM (BCBA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:FOJUT
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 1:14315 UNITED COLONIES DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5189
Mailing Address - Country:US
Mailing Address - Phone:908-986-2224
Mailing Address - Fax:
Practice Address - Street 1:145 COYKENDALL RD
Practice Address - Street 2:
Practice Address - City:WANTAGE
Practice Address - State:NJ
Practice Address - Zip Code:07461-3055
Practice Address - Country:US
Practice Address - Phone:908-986-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-09-5180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst