Provider Demographics
NPI:1376959171
Name:HITCHCOCK, MICHAEL (MA, BCABA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:MA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 FRONTIER WAY
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7820
Mailing Address - Country:US
Mailing Address - Phone:732-829-2005
Mailing Address - Fax:
Practice Address - Street 1:79 COUNTY ROAD 520
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8475
Practice Address - Country:US
Practice Address - Phone:732-972-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-13-5589103K00000X
NJ1-15-19095103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst