Provider Demographics
NPI:1841655057
Name:GEWIRTZMAN, CARYN (BCBA)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:GEWIRTZMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CARYN
Other - Middle Name:
Other - Last Name:PEPOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:111 CLOVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2503
Mailing Address - Country:US
Mailing Address - Phone:201-843-3274
Mailing Address - Fax:
Practice Address - Street 1:38 RIVER EDGE RD STE B
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2442
Practice Address - Country:US
Practice Address - Phone:201-843-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-14-10184103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst