Provider Demographics
NPI:1568032209
Name:ERCOLANI, MARISSA LYNN (RBT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:ERCOLANI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4846
Mailing Address - Country:US
Mailing Address - Phone:856-701-7494
Mailing Address - Fax:
Practice Address - Street 1:1 ALDWORTH CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-3330
Practice Address - Country:US
Practice Address - Phone:856-701-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician