Provider Demographics
NPI:1801685813
Name:PARKS, MEGAN (BCBA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PARKS
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 GLENWILD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1432
Mailing Address - Country:US
Mailing Address - Phone:973-713-6694
Mailing Address - Fax:973-713-6694
Practice Address - Street 1:281 GLENWILD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1432
Practice Address - Country:US
Practice Address - Phone:973-713-6694
Practice Address - Fax:973-713-6694
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-12-11399103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst