Provider Demographics
NPI:1679283253
Name:GOERLICH, DANIELLE R (BCBA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:GOERLICH
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 1:355 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2030
Mailing Address - Country:US
Mailing Address - Phone:603-867-3514
Mailing Address - Fax:
Practice Address - Street 1:78 NORTHEASTERN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3179
Practice Address - Country:US
Practice Address - Phone:603-389-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4191103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst