Provider Demographics
NPI:1760094072
Name:ETTINGER, PAUL HOWARD (BCBA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HOWARD
Last Name:ETTINGER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 PETER FORMAN DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9347
Mailing Address - Country:US
Mailing Address - Phone:908-839-8563
Mailing Address - Fax:
Practice Address - Street 1:92 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-5346
Practice Address - Country:US
Practice Address - Phone:908-839-8563
Practice Address - Fax:888-882-7527
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-43645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst