Provider Demographics
NPI:1518302074
Name:LAMM, MAUREEN J (MED BCBA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:J
Last Name:LAMM
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9125
Mailing Address - Country:US
Mailing Address - Phone:973-907-0046
Mailing Address - Fax:
Practice Address - Street 1:71 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9125
Practice Address - Country:US
Practice Address - Phone:973-907-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid
NJ22099OtherBCBSNJ BLUE CARD