Provider Demographics
NPI:1669900940
Name:DUTTON, DANIELLE (BCBA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DUTTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1548
Mailing Address - Country:US
Mailing Address - Phone:646-780-9227
Mailing Address - Fax:
Practice Address - Street 1:248 E 49TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1548
Practice Address - Country:US
Practice Address - Phone:646-780-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002227103K00000X
MI7401001207103K00000X
106S00000X
MI1-17-26848103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215270095Medicaid