Provider Demographics
NPI:1548748429
Name:RIVIELLO, AMANDA PATRICIA (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PATRICIA
Last Name:RIVIELLO
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 COUNTY ROAD 5320
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:MO
Mailing Address - Zip Code:65789-9445
Mailing Address - Country:US
Mailing Address - Phone:573-883-6761
Mailing Address - Fax:
Practice Address - Street 1:6749 COUNTY ROAD 2660
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-8147
Practice Address - Country:US
Practice Address - Phone:417-372-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019015604103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst