Provider Demographics
NPI:1043981640
Name:SRIRAMLU, MONICA GOPAL (BCBA, MS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:GOPAL
Last Name:SRIRAMLU
Suffix:
Gender:F
Credentials:BCBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E WASHINGTON ST APT 1909
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2190
Mailing Address - Country:US
Mailing Address - Phone:312-978-9690
Mailing Address - Fax:
Practice Address - Street 1:55 E WASHINGTON ST APT 1909
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2190
Practice Address - Country:US
Practice Address - Phone:312-978-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-22-60267103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty