Healthcare Provider Details

I. General information

NPI: 1154133486
Provider Name (Legal Business Name): DANIELLE FACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WYCKOFF AVE STE 3
MAHWAH NJ
07430-3285
US

IV. Provider business mailing address

1000 WYCKOFF AVE FLOOR 3/SUITE 7330
MAHWAH NJ
07430
US

V. Phone/Fax

Practice location:
  • Phone: 201-477-0079
  • Fax:
Mailing address:
  • Phone: 201-477-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: