Provider Demographics
NPI:1316708969
Name:QUERZOLA, LUIS A (RBT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:QUERZOLA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622A SHALER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-3722
Mailing Address - Country:US
Mailing Address - Phone:551-455-1920
Mailing Address - Fax:
Practice Address - Street 1:622A SHALER BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-3722
Practice Address - Country:US
Practice Address - Phone:551-455-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-23-268357106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician