MEDICARE: MRS. MARCELLA DIAMANTINO ANDRADE M.A., BCBA, LBA

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	3568	NC

General Provider Information

NPI Number	:	1649134123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCELLA DIAMANTINO ANDRADE M.A., BCBA, LBA

Provider Business Mailing Address
First Line	:	8106 WHITEGROVE RD
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-1611
Country	:	US
Telephone Number	:	980-257-3852
Fax Number	:

Provider Business Practice Location Address
First Line	:	8106 WHITEGROVE RD
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-1611
Country	:	US
Telephone Number	:	980-257-3852
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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