MEDICARE: STEPHANIE CIARAVOLO MS, 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

General Provider Information

NPI Number	:	1881000305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CIARAVOLO MS, BCBA

Provider Business Mailing Address
First Line	:	1235 SUNSET RIDGE RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-4803
Country	:	US
Telephone Number	:	516-655-8159
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 CHARLOTTE PIKE STE 2057
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-2926
Country	:	US
Telephone Number	:	628-250-7500
Fax Number	:

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

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	03/02/2023

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