Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 12147894 | NJ |
NPI | 1003491804 |
---|---|
Provider Name | Angela Terese Mellone |
First Address | Brick, NJ 08724-2021 |
Second Address | Red Bank, NJ 07701-6749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2021 |
Last Update Date | 23/04/2021 |