Provider Demographics
NPI:1710542063
Name:HAN, JUNG (RBT)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:825 GEORGES RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3357
Mailing Address - Country:US
Mailing Address - Phone:732-227-4050
Mailing Address - Fax:732-828-8248
Practice Address - Street 1:825 GEORGES RD STE 2
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3357
Practice Address - Country:US
Practice Address - Phone:732-227-4050
Practice Address - Fax:732-828-8248
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-17-40462106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician