Provider Demographics
NPI:1508214339
Name:BRANDSTEIN, MARLENA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:
Last Name:BRANDSTEIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARLENA
Other - Middle Name:
Other - Last Name:LURIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:4 NESHAMINY INTERPLEX DR STE 202
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1243 EASTON RD STE 103
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-3801
Practice Address - Country:US
Practice Address - Phone:267-217-3585
Practice Address - Fax:267-657-1341
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18633OtherBCBS
MA1303287OtherMBHP
MA99618201OtherNETWORK HEALTH
MA042611055OtherTAX ID
MA1004745OtherFALLON
MA0000023532OtherBMC
MA1004745OtherNHP