Provider Demographics
NPI:1245747732
Name:LOIHLE, RAYMOND WILLIAM III (BCBA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:LOIHLE
Suffix:III
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 1:601 US HIGHWAY 46 W
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-3118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 US HIGHWAY 46 W
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-3118
Practice Address - Country:US
Practice Address - Phone:201-660-8270
Practice Address - Fax:201-660-8271
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-28573103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-28573OtherBACB CERTIFICATION NUMBER