Provider Demographics
NPI:1104689553
Name:APOLLO, ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:APOLLO
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 1:270 ORCHARD TER APT 31
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1269
Mailing Address - Country:US
Mailing Address - Phone:201-790-4606
Mailing Address - Fax:
Practice Address - Street 1:270 ORCHARD TER APT 31
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1269
Practice Address - Country:US
Practice Address - Phone:201-790-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-51230103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst