Active NPI
Charles Willis Fanelli, BCBA
- Behavior Analyst
- Bethesda, MD
National Provider Identifier
1285379719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- LBA1279
- Practice address
- 5272 River Rd Ste 100
Bethesda, MD 20816-1454 - Phone
- (301) 718-1716
- NPI assigned
- Apr 29, 2022
- Last updated
- Apr 29, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | LBA1279 | MD | Primary |
Addresses
Primary practice location
5272 River Rd Ste 100
Bethesda, MD 20816-1454
Mailing address
5272 River Rd Ste 100
Bethesda, MD 20816-1454
Phone (301) 718-1716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LBA1279 | MD | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimal Beginnings, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Behavior Analyst
- Bethesda, MD
- NPI 1073888335
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651190400000",
"number": "1285379719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5272 RIVER RD STE 100",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208161454",
"telephone_number": "301-718-1716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5272 RIVER RD STE 100",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208161454",
"telephone_number": "301-718-1716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANELLI",
"first_name": "CHARLES",
"middle_name": "WILLIS",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-29",
"last_updated": "2022-04-29",
"certification_date": "2022-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MD",
"license": "LBA1279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.