Provider Demographics
NPI:1972038453
Name:SIANO, GABRIELLE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:SIANO
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 AIRPORT RD STE 1800
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7035
Mailing Address - Country:US
Mailing Address - Phone:732-523-1245
Mailing Address - Fax:
Practice Address - Street 1:150 AIRPORT RD STE 1800
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-7035
Practice Address - Country:US
Practice Address - Phone:732-523-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-25041103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst