Provider Demographics
NPI:1306352620
Name:POGGI, AUDREY (BCBA)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:POGGI
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 1:97 CRENSHAW DR
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-4721
Mailing Address - Country:US
Mailing Address - Phone:973-479-5846
Mailing Address - Fax:
Practice Address - Street 1:97 CRENSHAW DR
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-4721
Practice Address - Country:US
Practice Address - Phone:973-479-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst