Provider Demographics
NPI:1689382525
Name:BERTINO, SHELLEY (BCBA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BERTINO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NICHOLAS CT
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1619
Mailing Address - Country:US
Mailing Address - Phone:609-774-1223
Mailing Address - Fax:
Practice Address - Street 1:151 RYDERS LN
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-8557
Practice Address - Country:US
Practice Address - Phone:848-702-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst