Provider Demographics
NPI:1871122283
Name:FOGLIETTA, ANDREA (BCABA 0-17-8319)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FOGLIETTA
Suffix:
Gender:F
Credentials:BCABA 0-17-8319
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-2612
Mailing Address - Country:US
Mailing Address - Phone:856-528-7183
Mailing Address - Fax:
Practice Address - Street 1:2 PIN OAK LN
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1632
Practice Address - Country:US
Practice Address - Phone:856-669-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-17-8319103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst