Provider Demographics
NPI:1568023836
Name:RICHARDELLA, ANNA E (MS BCBA)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:E
Last Name:RICHARDELLA
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:E
Other - Last Name:SIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2757
Practice Address - Country:US
Practice Address - Phone:732-770-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-19-34777103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst