Provider Demographics
NPI:1609422021
Name:MOORE, DANIELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:CROGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8820 WALTER WAY UNIT 1310
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-0758
Mailing Address - Country:US
Mailing Address - Phone:856-381-1768
Mailing Address - Fax:
Practice Address - Street 1:3900 COLONIAL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1014
Practice Address - Country:US
Practice Address - Phone:239-237-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst