Provider Demographics
NPI:1225417645
Name:LIZOTTE, TRACY C (BCBA)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:C
Last Name:LIZOTTE
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 1:22 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1539
Mailing Address - Country:US
Mailing Address - Phone:201-390-4643
Mailing Address - Fax:
Practice Address - Street 1:22 REMINGTON ST
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1539
Practice Address - Country:US
Practice Address - Phone:201-390-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst