Individual
LISA MARIE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
496 RENA CT, BRICK, NJ 08724-7150
(848) 448-4002
Mailing address
496 RENA CT, BRICK, NJ 08724-7150
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-15120
NJ
103K00000X
Behavior Analyst
3245
NC
103K00000X
Behavior Analyst
—
NC
Other
Enumeration date
04/14/2014
Last updated
08/19/2025
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