Provider Demographics
NPI:1447048475
Name:MUCELLIN, JENNIFER (MA, BCBA, LBS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MUCELLIN
Suffix:
Gender:
Credentials:MA, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3101
Mailing Address - Country:US
Mailing Address - Phone:610-730-8677
Mailing Address - Fax:
Practice Address - Street 1:600 REED RD STE 101
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3505
Practice Address - Country:US
Practice Address - Phone:484-326-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007489103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst