Provider Demographics
NPI:1316451362
Name:PORRECA, ANTHONY (BCBA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PORRECA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1904
Mailing Address - Country:US
Mailing Address - Phone:201-638-9974
Mailing Address - Fax:
Practice Address - Street 1:825 GEORGES RD STE 2
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3357
Practice Address - Country:US
Practice Address - Phone:732-227-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-16-22194103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst