Healthcare Provider Details

I. General information

NPI: 1801124243
Provider Name (Legal Business Name): MICHAEL A TROTTA BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL TROTTA BCBA, LBA

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CAMBRIDGE CT
VINE GROVE KY
40175-5100
US

IV. Provider business mailing address

56 CAMBRIDGE CT
VINE GROVE KY
40175-5100
US

V. Phone/Fax

Practice location:
  • Phone: 270-501-0858
  • Fax: 270-828-5801
Mailing address:
  • Phone: 270-501-0858
  • Fax: 270-828-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: