Provider Demographics
NPI:1891206744
Name:MAYO, LISA JANE (BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:MAYO
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 1:12-77 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1833
Mailing Address - Country:US
Mailing Address - Phone:201-638-8387
Mailing Address - Fax:
Practice Address - Street 1:12-77 GEORGE ST
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1833
Practice Address - Country:US
Practice Address - Phone:201-638-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst