Provider Demographics
NPI:1073100160
Name:TRILLIZIO, LAURA (BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TRILLIZIO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7412
Mailing Address - Country:US
Mailing Address - Phone:161-582-3404
Mailing Address - Fax:866-936-1472
Practice Address - Street 1:1313 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7412
Practice Address - Country:US
Practice Address - Phone:615-823-4041
Practice Address - Fax:866-936-1472
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-18-30687103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service