Provider Demographics
NPI:1518496629
Name:SGAMBATI, LISAMARIE (MSED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LISAMARIE
Middle Name:
Last Name:SGAMBATI
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DUMONT AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3043
Mailing Address - Country:US
Mailing Address - Phone:201-803-7271
Mailing Address - Fax:
Practice Address - Street 1:121 DUMONT AVE FL 1
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3043
Practice Address - Country:US
Practice Address - Phone:201-803-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13467103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst