Healthcare Provider Details

I. General information

NPI: 1013698448
Provider Name (Legal Business Name): MADELINE DICERBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COVEY PL
MONROEVILLE NJ
08343-2518
US

IV. Provider business mailing address

18 CONESTOGA RD
CLEMENTON NJ
08021-5306
US

V. Phone/Fax

Practice location:
  • Phone: 609-579-2651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB498035
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: