Provider Demographics
NPI:1285017913
Name:SOUZA BERTONE, CRISTIANE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:CRISTIANE
Middle Name:
Last Name:SOUZA BERTONE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:CRISTIANE
Other - Middle Name:
Other - Last Name:BERNARDI DE SOUZA BERTONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BBCBA
Mailing Address - Street 1:11 TICE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6710
Mailing Address - Country:US
Mailing Address - Phone:973-951-1871
Mailing Address - Fax:
Practice Address - Street 1:11 TICE CT
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6710
Practice Address - Country:US
Practice Address - Phone:973-951-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000567103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst