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NPI Code Detail

MEDICARE: MR. MICHAEL PERILLO III BCBA, LBA

MEDICARE: MR. MICHAEL PERILLO III BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-14-17655IL
2103K00000XBehavior AnalystLBA1597MD
3103K00000XBehavior Analyst0133002119VA

General Provider Information

NPI Number : 1891188744
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL PERILLO III BCBA, LBA
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-244-1818
Fax Number :
Provider Business Practice Location Address
First Line : 5500 CHEROKEE AVE STE 120
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22312-2321
Country : US
Telephone Number : 703-832-4934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2015
Last Update Date : 01/12/2024

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