Provider Demographics
NPI:1639318660
Name:MANILOFF, ELLEN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MANILOFF
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WRENTHAM DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3825
Mailing Address - Country:US
Mailing Address - Phone:609-953-7673
Mailing Address - Fax:
Practice Address - Street 1:32 WRENTHAM DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3825
Practice Address - Country:US
Practice Address - Phone:609-953-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-03-1355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst