MEDICARE: PETER JOSEPH GENCARELLI MAP, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	14278791-2506	UT

General Provider Information

NPI Number	:	1689515082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER JOSEPH GENCARELLI MAP, BCBA

Provider Business Mailing Address
First Line	:	PO BOX 30180
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 W 12600 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7215
Country	:	US
Telephone Number	:	801-285-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2026
Last Update Date	:	04/14/2026

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