Provider Demographics
NPI:1831582170
Name:SHCHERBAKOV, ANTON (PSYD, BCBA)
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:SHCHERBAKOV
Suffix:
Gender:M
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-0012
Mailing Address - Country:US
Mailing Address - Phone:609-436-0193
Mailing Address - Fax:
Practice Address - Street 1:199 6TH AVE STE A2
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9749
Practice Address - Country:US
Practice Address - Phone:609-436-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00592000103TC2200X, 103TC0700X, 103TB0200X
NJ1-14-16071103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral