Provider Demographics
NPI:1073123253
Name:BACSKOCZKY, KENDALL JULIETTE (BCBA)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:JULIETTE
Last Name:BACSKOCZKY
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 1:42 RED BANK RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1760
Mailing Address - Country:US
Mailing Address - Phone:732-425-0344
Mailing Address - Fax:
Practice Address - Street 1:3425 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3554
Practice Address - Country:US
Practice Address - Phone:732-994-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-43525103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst