Provider Demographics
NPI:1043729197
Name:COACHING FROM EXPERIENCE
Entity Type:Organization
Organization Name:COACHING FROM EXPERIENCE
Other - Org Name:COACHING FROM EXPERIENCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:908-424-9198
Mailing Address - Street 1:233 MOUNT AIRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2338
Mailing Address - Country:US
Mailing Address - Phone:908-424-9198
Mailing Address - Fax:
Practice Address - Street 1:233 MOUNT AIRY RD STE 100
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2338
Practice Address - Country:US
Practice Address - Phone:908-424-9198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0594342Medicaid