Provider Demographics
NPI:1235741570
Name:AMEZQUITA, MARIANNY GISELLE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:MARIANNY
Middle Name:GISELLE
Last Name:AMEZQUITA
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 3RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-7617
Mailing Address - Country:US
Mailing Address - Phone:973-572-7729
Mailing Address - Fax:
Practice Address - Street 1:329 AYCRIGG AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3713
Practice Address - Country:US
Practice Address - Phone:973-471-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst