Provider Demographics
NPI:1285270850
Name:PANETTA-HAGAN, LENORA (RBT)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:
Last Name:PANETTA-HAGAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIRCHFIELD DRIVE
Mailing Address - Street 2:SUITE 801
Mailing Address - City:MT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-631-1223
Mailing Address - Fax:
Practice Address - Street 1:800 BIRCHFIELD DRIVE
Practice Address - Street 2:SUITE 801
Practice Address - City:MT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-631-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-16-18355106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician