Provider Demographics
NPI:1649845520
Name:VONDERSCHMIDT, EDWARD CHRISTIAN III (MA, BCBA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHRISTIAN
Last Name:VONDERSCHMIDT
Suffix:III
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 KINGS HWY E STE 200
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2008
Mailing Address - Country:US
Mailing Address - Phone:609-744-3737
Mailing Address - Fax:
Practice Address - Street 1:11 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3123
Practice Address - Country:US
Practice Address - Phone:609-744-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-16-24614103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst