Provider Demographics
NPI:1245984285
Name:WILLNER, ADINA (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:ADINA
Middle Name:
Last Name:WILLNER
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17A SHAYAS RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5564
Mailing Address - Country:US
Mailing Address - Phone:845-263-5370
Mailing Address - Fax:
Practice Address - Street 1:1950 RUTGERS UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4537
Practice Address - Country:US
Practice Address - Phone:718-304-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12257444103K00000X
NY002260103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst