Provider Demographics
NPI:1649866146
Name:MIZRACHI, SHOSHANA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:MIZRACHI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 N APPLE ST APT B
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1408
Mailing Address - Country:US
Mailing Address - Phone:973-558-1229
Mailing Address - Fax:
Practice Address - Street 1:25 N APPLE ST APT B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1408
Practice Address - Country:US
Practice Address - Phone:973-558-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst