Provider Demographics
NPI:1144610874
Name:MOERLEIN, ADRIENNE FARR (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:FARR
Last Name:MOERLEIN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BOYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1617
Mailing Address - Country:US
Mailing Address - Phone:512-554-3463
Mailing Address - Fax:
Practice Address - Street 1:1919 24TH AVE
Practice Address - Street 2:APT L701
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3432
Practice Address - Country:US
Practice Address - Phone:512-554-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst