Provider Demographics
NPI:1295112969
Name:FELLMAN, DANIELLE (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:FELLMAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:SCHATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:83 BERTOLOTTO AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-2102
Mailing Address - Country:US
Mailing Address - Phone:201-638-7492
Mailing Address - Fax:
Practice Address - Street 1:83 BERTOLOTTO AVE FL 2
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-2102
Practice Address - Country:US
Practice Address - Phone:201-638-7492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst