Provider Demographics
NPI:1154782100
Name:HAIR, DENISE MARIA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIA
Last Name:HAIR
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3941
Mailing Address - Country:US
Mailing Address - Phone:215-499-6045
Mailing Address - Fax:
Practice Address - Street 1:5150 MALLARD DR
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3941
Practice Address - Country:US
Practice Address - Phone:215-499-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-13-13248103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst