Provider Demographics
NPI:1053913962
Name:WIEDOW, LUANNE (BCBA)
Entity type:Individual
Prefix:
First Name:LUANNE
Middle Name:
Last Name:WIEDOW
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WALDEN CT
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1802
Mailing Address - Country:US
Mailing Address - Phone:862-251-2780
Mailing Address - Fax:
Practice Address - Street 1:119 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1611
Practice Address - Country:US
Practice Address - Phone:862-251-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst