MEDICARE: DANICA DAVIDMAN MA, BCBA

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	1-12-10246	NJ

General Provider Information

NPI Number	:	1518221688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANICA DAVIDMAN MA, BCBA

Provider Business Mailing Address
First Line	:	31 VOSE AVE
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-6400
Country	:	US
Telephone Number	:	973-761-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 VOSE AVE
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-6400
Country	:	US
Telephone Number	:	973-761-5141
Fax Number	:

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

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	04/16/2014

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