Provider Demographics
NPI:1134531841
Name:HANSEN, THOMAS MATTHEW (BCBA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:HANSEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2723
Mailing Address - Country:US
Mailing Address - Phone:201-658-1465
Mailing Address - Fax:
Practice Address - Street 1:524 10TH ST
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2723
Practice Address - Country:US
Practice Address - Phone:201-658-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-14662103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst