Provider Demographics
NPI:1104365535
Name:SIDENER, DAVID (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SIDENER
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4535
Mailing Address - Country:US
Mailing Address - Phone:973-362-8484
Mailing Address - Fax:
Practice Address - Street 1:36 BIRCH ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4535
Practice Address - Country:US
Practice Address - Phone:973-362-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst