Provider Demographics
NPI:1760149017
Name:GREEN, RANDEE LEE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:RANDEE
Middle Name:LEE
Last Name:GREEN
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 1:14 TOMAHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:WANTAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-1439
Mailing Address - Country:US
Mailing Address - Phone:973-997-7823
Mailing Address - Fax:
Practice Address - Street 1:7 REGENT ST STE 708
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1628
Practice Address - Country:US
Practice Address - Phone:551-237-4646
Practice Address - Fax:201-603-1810
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-55754103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty