Provider Demographics
NPI:1649859844
Name:NELSON, BRIANNA ALISSA (MS)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ALISSA
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08346-2034
Mailing Address - Country:US
Mailing Address - Phone:609-892-8072
Mailing Address - Fax:
Practice Address - Street 1:1800 CHAPEL AVE W STE 160
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4605
Practice Address - Country:US
Practice Address - Phone:856-346-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12043336103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst