Provider Demographics
NPI:1093691172
Name:ANDERSON, DAE-JELL (RBT)
Entity type:Individual
Prefix:
First Name:DAE-JELL
Middle Name:
Last Name:ANDERSON
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 1:10 LIGHT ST UNIT 1024
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1479
Mailing Address - Country:US
Mailing Address - Phone:203-212-0711
Mailing Address - Fax:
Practice Address - Street 1:10 LIGHT ST UNIT 1024
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1479
Practice Address - Country:US
Practice Address - Phone:203-212-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician