Provider Demographics
NPI:1285952945
Name:STICKEL, CHERYL DIANE (LSW, BCBA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DIANE
Last Name:STICKEL
Suffix:
Gender:F
Credentials:LSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1917
Mailing Address - Country:US
Mailing Address - Phone:908-884-3207
Mailing Address - Fax:908-835-8300
Practice Address - Street 1:2 W WASHINGTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1917
Practice Address - Country:US
Practice Address - Phone:908-884-3207
Practice Address - Fax:908-835-8300
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05205200101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health