Provider Demographics
NPI:1932601226
Name:NARDIELLO, JUSTINE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:NARDIELLO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:5 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1201
Mailing Address - Country:US
Mailing Address - Phone:408-772-3080
Mailing Address - Fax:
Practice Address - Street 1:228 HAMILTON AVE FL 3
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2583
Practice Address - Country:US
Practice Address - Phone:408-772-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1-21-49189103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician