Provider Demographics
NPI:1487354973
Name:BORELLI, NYASIA MARIE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:NYASIA
Middle Name:MARIE
Last Name:BORELLI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5502
Mailing Address - Country:US
Mailing Address - Phone:201-899-5369
Mailing Address - Fax:
Practice Address - Street 1:60 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5502
Practice Address - Country:US
Practice Address - Phone:201-899-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-22-59557103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty