Provider Demographics
NPI:1023524683
Name:BRANCATO, JUSTINE (MAT, BCBA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:BRANCATO
Suffix:
Gender:F
Credentials:MAT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-2042
Mailing Address - Country:US
Mailing Address - Phone:908-328-2899
Mailing Address - Fax:
Practice Address - Street 1:466 ROUTE 12
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4107
Practice Address - Country:US
Practice Address - Phone:908-328-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst