Provider Demographics
NPI:1114684271
Name:ALTMAN, SAMANTHA LINDSEY (BCBA)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LINDSEY
Last Name:ALTMAN
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:-51 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3730
Mailing Address - Country:US
Mailing Address - Phone:201-835-5917
Mailing Address - Fax:
Practice Address - Street 1:31-11 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3951
Practice Address - Country:US
Practice Address - Phone:201-742-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBACB557380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst