Provider Demographics
NPI:1255862397
Name:VERHOEVEN, ROBERT (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:VERHOEVEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5243
Mailing Address - Country:US
Mailing Address - Phone:908-499-4958
Mailing Address - Fax:
Practice Address - Street 1:1345 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5243
Practice Address - Country:US
Practice Address - Phone:908-499-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-16-21774103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst