Provider Demographics
NPI:1003617523
Name:YANCY, DANIEL JR
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:YANCY
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-8349
Mailing Address - Country:US
Mailing Address - Phone:856-842-8901
Mailing Address - Fax:
Practice Address - Street 1:300 WILSON AVE
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-8349
Practice Address - Country:US
Practice Address - Phone:856-842-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15BC00114200103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst