Healthcare Provider Details

I. General information

NPI: 1306750526
Provider Name (Legal Business Name): KRISTINA DICLERICO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E GATE DR
CHERRY HILL NJ
08034-2803
US

IV. Provider business mailing address

839 JACKSON RD
MAYS LANDING NJ
08330-4704
US

V. Phone/Fax

Practice location:
  • Phone: 856-810-7599
  • Fax:
Mailing address:
  • Phone: 856-810-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: