Healthcare Provider Details

I. General information

NPI: 1477170652
Provider Name (Legal Business Name): VITTORIA A PETERSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VITTORIA GABRIELLI

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CEDAR HILL ST STE 200
MARLBOROUGH MA
01752-5900
US

IV. Provider business mailing address

225 CEDAR HILL ST STE 200
MARLBOROUGH MA
01752-5900
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: