MEDICARE: MELISSA CHICHELO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-11-9391	NJ

General Provider Information

NPI Number	:	1457627671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CHICHELO

Provider Business Mailing Address
First Line	:	351 GETTYSBURG WAY
Second Line	:
City	:	LINCOLN PARK
State	:	NJ
Zip	:	07035-1837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 GETTYSBURG WAY
Second Line	:
City	:	LINCOLN PARK
State	:	NJ
Zip	:	07035-1837
Country	:	US
Telephone Number	:	973-768-3169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/02/2012

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Directions to “ MELISSA CHICHELO ” Practice Location

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