Provider Demographics
NPI:1639557077
Name:PUTIGNANO, DONNA (BCBA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:PUTIGNANO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DONNNA
Other - Middle Name:A
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:280 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1645
Mailing Address - Country:US
Mailing Address - Phone:856-767-5757
Mailing Address - Fax:
Practice Address - Street 1:280 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1645
Practice Address - Country:US
Practice Address - Phone:856-767-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13240103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1396169579Medicaid
NJ1396169579Medicaid