Provider Demographics
NPI:1013519271
Name:EDWARDS, REGAN ANTHONY (BCBA)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:ANTHONY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3929
Mailing Address - Country:US
Mailing Address - Phone:908-531-2332
Mailing Address - Fax:
Practice Address - Street 1:29 TERRY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3929
Practice Address - Country:US
Practice Address - Phone:908-531-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst