Provider Demographics
NPI:1295226603
Name:BOTELHO, DANIELLE ANDRADE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANDRADE
Last Name:BOTELHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PAKE ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3023
Mailing Address - Country:US
Mailing Address - Phone:201-895-1076
Mailing Address - Fax:
Practice Address - Street 1:133 PAKE ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3023
Practice Address - Country:US
Practice Address - Phone:201-895-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst