Healthcare Provider Details

I. General information

NPI: 1912764507
Provider Name (Legal Business Name): IVANA IZZO BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANFORD DR
FARMINGTON CT
06032-2474
US

IV. Provider business mailing address

326 W MAIN ST STE 210
MILFORD CT
06460-2560
US

V. Phone/Fax

Practice location:
  • Phone: 860-321-8604
  • Fax:
Mailing address:
  • Phone: 203-283-7027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1862
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: