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General NPI Number Information
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NPI Number | 1700308731
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Entity Type | Individual
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Provider Name | TAMARLA RAELYNN PONTICELLI M.ED, BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 300 WELSH RD STE 100
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City | HORSHAM
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State | PA
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Zip | 19044-2248
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Country | US
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Telephone | 267-209-3410
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Fax |
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Provider Business Mailing Address
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Address Line | 3351 CARROLL CT
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City | BENSALEM
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State | PA
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Zip | 19020-1817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11935456
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License Number State |
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