Provider Demographics
NPI:1336662485
Name:KILGALLON, DANIEL P (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:KILGALLON
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CENTENNIAL BLVD UNIT 1345
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-6056
Mailing Address - Country:US
Mailing Address - Phone:610-322-3319
Mailing Address - Fax:
Practice Address - Street 1:12 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1726
Practice Address - Country:US
Practice Address - Phone:610-322-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-23639103K00000X
1-16-23939103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst