Provider Demographics
NPI:1689086068
Name:VITOLO, KERRI (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:
Last Name:VITOLO
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 1:53 ROCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2726
Mailing Address - Country:US
Mailing Address - Phone:203-733-1190
Mailing Address - Fax:
Practice Address - Street 1:53 ROCKY HILL RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-2726
Practice Address - Country:US
Practice Address - Phone:203-733-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-15122103K00000X
NY1156201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist