Provider Demographics
NPI:1568741676
Name:RESTIVO, GINA MARIE (PSYD, BCBA-D, NCSP)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:RESTIVO
Suffix:
Gender:F
Credentials:PSYD, BCBA-D, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PELHAM PL
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1613
Mailing Address - Country:US
Mailing Address - Phone:551-486-9848
Mailing Address - Fax:
Practice Address - Street 1:20 PELHAM PL
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1613
Practice Address - Country:US
Practice Address - Phone:551-486-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-05-2413103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst