MEDICARE: MRS. DANIELLE FELLMAN M.A., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		NJ

General Provider Information

NPI Number	:	1295112969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE FELLMAN M.A., BCBA

Provider Business Mailing Address
First Line	:	83 BERTOLOTTO AVE FL 2
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-2102
Country	:	US
Telephone Number	:	201-638-7492
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 BERTOLOTTO AVE FL 2
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-2102
Country	:	US
Telephone Number	:	201-638-7492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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