Provider Demographics
NPI:1275341968
Name:BAVISKAR, NIKITA SATISH (BCBA)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:SATISH
Last Name:BAVISKAR
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 1:28 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4867
Mailing Address - Country:US
Mailing Address - Phone:732-841-7734
Mailing Address - Fax:
Practice Address - Street 1:40 CHRISTOPHER WAY STE 103
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3346
Practice Address - Country:US
Practice Address - Phone:732-841-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-24-78349103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst