1295959443 NPI number — MRS. STEPHANY CRISOLO AIELLO M.ED., BCBA

Table of content: MRS. STEPHANY CRISOLO AIELLO M.ED., BCBA (NPI 1295959443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295959443 NPI number — MRS. STEPHANY CRISOLO AIELLO M.ED., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AIELLO
Provider First Name:
STEPHANY
Provider Middle Name:
CRISOLO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRISOLO
Provider Other First Name:
STEPHANY
Provider Other Middle Name:
SUPNET
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295959443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2075 SILENCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95148-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-821-6673
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 PARKMOOR AVE
Provider Second Line Business Practice Location Address:
STE #208
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-989-3417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-15-18780 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com