Provider Demographics
NPI:1912357807
Name:CHRYSSIKOS, DANIELLE (MAT, BCBA, BA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CHRYSSIKOS
Suffix:
Gender:F
Credentials:MAT, BCBA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-6818
Mailing Address - Country:US
Mailing Address - Phone:732-675-2334
Mailing Address - Fax:
Practice Address - Street 1:301 AMBOY RD
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-6818
Practice Address - Country:US
Practice Address - Phone:732-675-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-06-3050103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst