Provider Demographics
NPI:1083122600
Name:CIRAULO, SALVATORE STEVEN (BCBA)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:STEVEN
Last Name:CIRAULO
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 1:1234 W CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1818
Mailing Address - Country:US
Mailing Address - Phone:810-487-5571
Mailing Address - Fax:989-709-5414
Practice Address - Street 1:1234 W CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1818
Practice Address - Country:US
Practice Address - Phone:810-487-5571
Practice Address - Fax:989-709-5414
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-23-68395103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst