Provider Demographics
NPI:1780262741
Name:MARMION, ANDREW (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MARMION
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 MELVIN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08029-1028
Mailing Address - Country:US
Mailing Address - Phone:856-889-3981
Mailing Address - Fax:
Practice Address - Street 1:286 MANTUA GROVE RD
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08066-1738
Practice Address - Country:US
Practice Address - Phone:856-628-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-47763103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst