Provider Demographics
NPI:1225338080
Name:TIBERT, DANIELLE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:TIBERT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:ANNE
Other - Last Name:COTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:200 GRIFFIN RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7145
Mailing Address - Country:US
Mailing Address - Phone:800-778-5560
Mailing Address - Fax:
Practice Address - Street 1:200 GRIFFIN RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7145
Practice Address - Country:US
Practice Address - Phone:800-778-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-09-5712103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst