Provider Demographics
NPI:1568143345
Name:SIMON, BASYA (MSED BCBA)
Entity Type:Individual
Prefix:
First Name:BASYA
Middle Name:
Last Name:SIMON
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 1:58 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4701
Mailing Address - Country:US
Mailing Address - Phone:732-987-6006
Mailing Address - Fax:
Practice Address - Street 1:873 VINE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5351
Practice Address - Country:US
Practice Address - Phone:732-987-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty