Provider Demographics
NPI:1689454985
Name:URGILES, SHIRLEY CRYSTAL (BCBA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:CRYSTAL
Last Name:URGILES
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 1:3425 US 9
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3554
Mailing Address - Country:US
Mailing Address - Phone:732-994-7899
Mailing Address - Fax:
Practice Address - Street 1:3425 US 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3554
Practice Address - Country:US
Practice Address - Phone:732-994-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-23-68538103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst