Provider Demographics
NPI:1841778016
Name:VANDERSLICE, VANESSA (BCBA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VANDERSLICE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:CARDENAS-MACOUZET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:160 PENNS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-4713
Mailing Address - Country:US
Mailing Address - Phone:832-562-8461
Mailing Address - Fax:
Practice Address - Street 1:1405 FOULK RD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2769
Practice Address - Country:US
Practice Address - Phone:877-222-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16-26109106E00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst