Provider Demographics
NPI:1083014187
Name:SIRAVO, MICHAEL (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SIRAVO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 PARK POND WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7661
Mailing Address - Country:US
Mailing Address - Phone:321-355-3904
Mailing Address - Fax:407-255-6429
Practice Address - Street 1:2951 PARK POND WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7661
Practice Address - Country:US
Practice Address - Phone:321-355-3904
Practice Address - Fax:407-255-6429
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0146018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst