Provider Demographics
NPI:1871846329
Name:GERSTEN, TESSIE AHUVA (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:TESSIE
Middle Name:AHUVA
Last Name:GERSTEN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 PRINCETON AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2899
Mailing Address - Country:US
Mailing Address - Phone:732-966-3404
Mailing Address - Fax:732-901-1232
Practice Address - Street 1:308 MILLER RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2337
Practice Address - Country:US
Practice Address - Phone:732-966-3404
Practice Address - Fax:732-901-1232
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10340103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst