Provider Demographics
NPI:1386288942
Name:RUSSELL, JENEILLE (BCBA)
Entity type:Individual
Prefix:
First Name:JENEILLE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 SHOEMAKER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4238
Mailing Address - Country:US
Mailing Address - Phone:484-681-2170
Mailing Address - Fax:484-320-8307
Practice Address - Street 1:583 SHOEMAKER RD STE 230
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4238
Practice Address - Country:US
Practice Address - Phone:484-681-2170
Practice Address - Fax:484-320-8307
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NJ1-24-78214103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician