Provider Demographics
NPI:1497057004
Name:SLATTERY, FELICIA L (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:L
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-2112
Mailing Address - Country:US
Mailing Address - Phone:732-904-3928
Mailing Address - Fax:732-544-1089
Practice Address - Street 1:284 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-2112
Practice Address - Country:US
Practice Address - Phone:732-544-2021
Practice Address - Fax:732-544-1089
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst