Provider Demographics
NPI:1154070589
Name:EPSTEIN, GABRIELLE (BCBA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:GABBY
Other - Middle Name:
Other - Last Name:EPSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:37 MAISON PL
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4192
Mailing Address - Country:US
Mailing Address - Phone:856-701-4600
Mailing Address - Fax:
Practice Address - Street 1:1515 BURNT MILL RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3637
Practice Address - Country:US
Practice Address - Phone:856-599-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ205031260369106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE71132706260975Medicaid