Healthcare Provider Details

I. General information

NPI: 1801163696
Provider Name (Legal Business Name): LAUREN SIVELLE M.S.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 E CARY ST
RICHMOND VA
23223-6935
US

IV. Provider business mailing address

82 SYMMES RD
MANALAPAN NJ
07726-3235
US

V. Phone/Fax

Practice location:
  • Phone: 804-215-5600
  • Fax:
Mailing address:
  • Phone: 347-693-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9233
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: