Provider Demographics
NPI:1437928793
Name:ROBERTS, BRENDA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:KOPELOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2309
Mailing Address - Country:US
Mailing Address - Phone:856-827-7630
Mailing Address - Fax:
Practice Address - Street 1:1166 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5677
Practice Address - Country:US
Practice Address - Phone:732-965-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-23-70404103K00000X
1-23-70404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst