Healthcare Provider Details

I. General information

NPI: 1629627831
Provider Name (Legal Business Name): DANIELLE MARIA EDERER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3744 W CHESTER PIKE
NEWTOWN SQUARE PA
19073-3224
US

IV. Provider business mailing address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

V. Phone/Fax

Practice location:
  • Phone: 844-924-0777
  • Fax:
Mailing address:
  • Phone: 847-807-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-37864
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: