Provider Demographics
NPI:1407069941
Name:PELLECCHIA, JANICE MARIE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:PELLECCHIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S STATE ST
Mailing Address - Street 2:15Q
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2964
Mailing Address - Country:US
Mailing Address - Phone:630-673-1211
Mailing Address - Fax:
Practice Address - Street 1:1530 S. STATE ST.
Practice Address - Street 2:15Q
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-9954
Practice Address - Country:US
Practice Address - Phone:630-673-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-03-1395103K00000X, 103TB0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-03-1395OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD (NATIONAL CERTIFICATION)