Provider Demographics
NPI:1144737651
Name:ORSINI, GINA (BCBA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ORSINI
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 1:50 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1327
Mailing Address - Country:US
Mailing Address - Phone:617-877-9757
Mailing Address - Fax:
Practice Address - Street 1:25 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2173
Practice Address - Country:US
Practice Address - Phone:617-877-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-13939OtherBACB