Provider Demographics
NPI:1437515418
Name:CARDELL, MARYVONNE CLAUDE (BCBA)
Entity Type:Individual
Prefix:
First Name:MARYVONNE
Middle Name:CLAUDE
Last Name:CARDELL
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 1:478 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2411
Mailing Address - Country:US
Mailing Address - Phone:201-943-1143
Mailing Address - Fax:201-943-2903
Practice Address - Street 1:478 ABBOTT AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2411
Practice Address - Country:US
Practice Address - Phone:201-943-1143
Practice Address - Fax:201-943-2903
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1-15-19493103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst