Provider Demographics
NPI:1144696733
Name:MOKRZECKI, ANNA (BCBA, LPC)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:MOKRZECKI
Suffix:
Gender:F
Credentials:BCBA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2309
Mailing Address - Country:US
Mailing Address - Phone:732-674-4599
Mailing Address - Fax:
Practice Address - Street 1:10 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2309
Practice Address - Country:US
Practice Address - Phone:732-674-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00510600101YP2500X
NJ1-15-19248103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional