Provider Demographics
NPI:1497114474
Name:PIETRZAK, ALICJA U (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ALICJA
Middle Name:U
Last Name:PIETRZAK
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 1:79 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2319
Mailing Address - Country:US
Mailing Address - Phone:347-782-8071
Mailing Address - Fax:
Practice Address - Street 1:60 EVERGREEN PL.
Practice Address - Street 2:3RD FLOOR SUITE 309
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017
Practice Address - Country:US
Practice Address - Phone:973-943-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-15-18757103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst