Provider Demographics
NPI:1174880637
Name:LIOTTA-KLECHA, SUSAN (BCBA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:LIOTTA-KLECHA
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 1:419 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1326
Mailing Address - Country:US
Mailing Address - Phone:201-563-8803
Mailing Address - Fax:201-576-9740
Practice Address - Street 1:419 MARION AVE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1326
Practice Address - Country:US
Practice Address - Phone:201-563-8803
Practice Address - Fax:201-576-9740
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst