Provider Demographics
NPI:1194278960
Name:SENF SHAGON, LAURA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:SENF SHAGON
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 1:1112 SILVER CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3523
Mailing Address - Country:US
Mailing Address - Phone:609-575-4584
Mailing Address - Fax:
Practice Address - Street 1:1112 SILVER CT
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3523
Practice Address - Country:US
Practice Address - Phone:609-575-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-15-17986103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst