Healthcare Provider Details

I. General information

NPI: 1932616828
Provider Name (Legal Business Name): DANIELLE PERCOCO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S 3RD ST STE 201
COLUMBUS OH
43215-4206
US

IV. Provider business mailing address

5930 WINSHIRE DR
CANAL WINCHESTER OH
43110-8795
US

V. Phone/Fax

Practice location:
  • Phone: 614-800-2751
  • Fax:
Mailing address:
  • Phone: 740-466-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58287
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17368763497
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: