Individual
ZACH J TIVALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
1000 CRAWFORD PL STE 260, MOUNT LAUREL, NJ 08054-3965
(732) 742-8315
Mailing address
1000 CRAWFORD PL STE 260, MOUNT LAUREL, NJ 08054-3965
(732) 742-8315
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-26985
NJ
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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