Provider Demographics
NPI:1518398056
Name:SCHRODER, MARTYNE SHANNON (BCBA)
Entity Type:Individual
Prefix:
First Name:MARTYNE
Middle Name:SHANNON
Last Name:SCHRODER
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 1:135 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7124
Mailing Address - Country:US
Mailing Address - Phone:201-407-7934
Mailing Address - Fax:
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7124
Practice Address - Country:US
Practice Address - Phone:201-407-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-08-4075103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst