Provider Demographics
NPI:1437656774
Name:LORUSSO, LEIGHANN ELIZABETH (BCBA)
Entity Type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:ELIZABETH
Last Name:LORUSSO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 WOODFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7117
Mailing Address - Country:US
Mailing Address - Phone:908-309-6446
Mailing Address - Fax:
Practice Address - Street 1:1612 WOODFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-7117
Practice Address - Country:US
Practice Address - Phone:908-309-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-26270103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst