Provider Demographics
NPI:1790585701
Name:DIDOMENICO, JUSTIN ANTONIO (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ANTONIO
Last Name:DIDOMENICO
Suffix:
Gender:
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 JONATHAN WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1036
Mailing Address - Country:US
Mailing Address - Phone:267-257-4505
Mailing Address - Fax:
Practice Address - Street 1:32 JONATHAN WAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1036
Practice Address - Country:US
Practice Address - Phone:267-257-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst