Healthcare Provider Details

I. General information

NPI: 1578236808
Provider Name (Legal Business Name): NICOLE M SIRAVO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE CRIPPS BCBA

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TERRY DR STE 105
NEWTOWN PA
18940-1896
US

IV. Provider business mailing address

140 TERRY DR STE 105
NEWTOWN PA
18940-1896
US

V. Phone/Fax

Practice location:
  • Phone: 215-704-9224
  • Fax:
Mailing address:
  • Phone: 215-704-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66607
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-178135
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: