Individual
MYRNA BASSAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
60 GRAND AVE STE 1, ENGLEWOOD, NJ 07631-6583
(201) 849-4565
(844) 364-3239
Mailing address
60 GRAND AVE STE 1, ENGLEWOOD, NJ 07631-6583
(551) 800-2441
(844) 364-3239
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BCBA 1-1314553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11314553
BCBA
CA
Enumeration date
07/29/2014
Last updated
10/11/2022
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