Healthcare Provider Details

I. General information

NPI: 1093385270
Provider Name (Legal Business Name): SETH ALEXANDER RIVETTI-SHARPE MA, BCBA, COBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SETH A SHARPE MA, BCBA, COBA, LBA

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HEALTH SCIENCES BLDG 3640 COLONEL GLENN HWY
DAYTON OH
45435-6743
US

IV. Provider business mailing address

2721 TAOS DR
MIAMISBURG OH
45342-6800
US

V. Phone/Fax

Practice location:
  • Phone: 937-775-3458
  • Fax:
Mailing address:
  • Phone: 812-374-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number493
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002563
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.00994
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-51007
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: