Provider Demographics
NPI:1083249791
Name:EDWARDS, VICTORIA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:EDWARDS
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 1:6142 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3750
Mailing Address - Country:US
Mailing Address - Phone:609-970-5792
Mailing Address - Fax:
Practice Address - Street 1:1515 SHORE RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2349
Practice Address - Country:US
Practice Address - Phone:609-970-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-20-114418106S00000X
NJ1-21-477952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician