Provider Demographics
NPI:1396093860
Name:KOWANTZ, ELIZABETH S (MA BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:KOWANTZ
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 EDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2938
Mailing Address - Country:US
Mailing Address - Phone:908-773-3710
Mailing Address - Fax:
Practice Address - Street 1:1621 EDGE ST
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2938
Practice Address - Country:US
Practice Address - Phone:908-773-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist