Provider Demographics
NPI:1215719950
Name:NOVELLO, DENISE M (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:NOVELLO
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5612
Mailing Address - Country:US
Mailing Address - Phone:631-418-7008
Mailing Address - Fax:
Practice Address - Street 1:41 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5612
Practice Address - Country:US
Practice Address - Phone:631-418-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst