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General NPI Number Information
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NPI Number | 1891188744
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Entity Type | Individual
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Provider Name | MICHAEL PERILLO III BCBA, LBA
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Gender | Male
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 5500 CHEROKEE AVE STE 120
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City | ALEXANDRIA
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State | VA
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Zip | 22312-2321
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Country | US
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Telephone | 703-832-4934
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S DOUGLAS RD STE 230
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City | CORAL GABLES
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State | FL
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Zip | 33134-4108
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Country | US
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Telephone | 844-244-1818
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-17655
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License Number State | IL
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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 | LBA1597
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133002119
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License Number State | VA
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