Healthcare Provider Details

I. General information

NPI: 1194643106
Provider Name (Legal Business Name): DAVID HANEMAN M.S.ED, BCBA, LBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48-6 REVERE RD APT 6
DREXEL HILL PA
19026-5367
US

IV. Provider business mailing address

12 TALL TREE CIR
BROOMALL PA
19008-1063
US

V. Phone/Fax

Practice location:
  • Phone: 646-683-0348
  • Fax:
Mailing address:
  • Phone: 215-280-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44694
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: