Provider Demographics
NPI:1710361779
Name:PISTONE, MISTELLA (BCBA)
Entity Type:Individual
Prefix:
First Name:MISTELLA
Middle Name:
Last Name:PISTONE
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 1:218 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2120
Mailing Address - Country:US
Mailing Address - Phone:609-502-2391
Mailing Address - Fax:
Practice Address - Street 1:84 EAVES MILL RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2327
Practice Address - Country:US
Practice Address - Phone:609-502-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11518861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst