Provider Demographics
NPI:1649078940
Name:DEMAREST, LEAH MAXINE (MS BCBA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MAXINE
Last Name:DEMAREST
Suffix:
Gender:
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 1:250 BIRCH HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4263
Mailing Address - Country:US
Mailing Address - Phone:609-575-7519
Mailing Address - Fax:
Practice Address - Street 1:250 BIRCH HOLLOW DR
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-4263
Practice Address - Country:US
Practice Address - Phone:609-575-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15BC00046300103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst