Provider Demographics
NPI:1346968955
Name:FURST, MINDY (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:FURST
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 PRINCETON AVE APT 313
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3693
Mailing Address - Country:US
Mailing Address - Phone:732-987-5534
Mailing Address - Fax:
Practice Address - Street 1:675 PRINCETON AVE APT 313
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3693
Practice Address - Country:US
Practice Address - Phone:732-987-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty