Provider Demographics
NPI:1699486001
Name:COUGHLIN, ALYSSA TAYLOR (BCBA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:TAYLOR
Last Name:COUGHLIN
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 1:325 BIRCH PKWY
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2830
Mailing Address - Country:US
Mailing Address - Phone:914-714-9558
Mailing Address - Fax:
Practice Address - Street 1:329 AYCRIGG AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3713
Practice Address - Country:US
Practice Address - Phone:973-471-3046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-53548103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst