Provider Demographics
NPI:1700278504
Name:LAWTON, MICHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LAWTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1453
Mailing Address - Country:US
Mailing Address - Phone:973-668-4806
Mailing Address - Fax:862-205-6072
Practice Address - Street 1:109 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1453
Practice Address - Country:US
Practice Address - Phone:973-668-4806
Practice Address - Fax:862-205-6072
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-09-5757222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist