Provider Demographics
NPI:1780255232
Name:SIETSMA, GABRIELLE VICTORIA (BCBA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:VICTORIA
Last Name:SIETSMA
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 1:51 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2756
Mailing Address - Country:US
Mailing Address - Phone:732-754-2179
Mailing Address - Fax:
Practice Address - Street 1:51 ROBERT ST
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2756
Practice Address - Country:US
Practice Address - Phone:732-754-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst