Provider Demographics
NPI:1194362475
Name:WILDFLOWER EDUCATIONAL, LLC
Entity Type:Organization
Organization Name:WILDFLOWER EDUCATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:201-693-8250
Mailing Address - Street 1:61 WHARTON AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1340
Mailing Address - Country:US
Mailing Address - Phone:201-693-8250
Mailing Address - Fax:
Practice Address - Street 1:61 WHARTON AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1340
Practice Address - Country:US
Practice Address - Phone:201-693-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty