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General NPI Number Information
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NPI Number | 1104227438
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Entity Type | Individual
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Provider Name | RENEE CRIVELLO BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 12871 TRADE WAY DR STE 1
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-7334
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Country | US
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Telephone | 786-259-0363
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Fax |
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Provider Business Mailing Address
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Address Line | 26676 MORTON AVE
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-6308
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Country | US
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Telephone | 908-451-5480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-47478
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License Number State |
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