Provider Demographics
NPI:1699037606
Name:DENTE, ELLEN THERESE (BCBA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:THERESE
Last Name:DENTE
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 1:225 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1139
Mailing Address - Country:US
Mailing Address - Phone:570-457-7268
Mailing Address - Fax:
Practice Address - Street 1:225 SPRING ST
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1139
Practice Address - Country:US
Practice Address - Phone:570-457-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-09-5865103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst