Provider Demographics
NPI:1255560116
Name:CIANCIOLO, STACY R (BCBA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:CIANCIOLO
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 1:2558 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1141
Mailing Address - Country:US
Mailing Address - Phone:216-287-6174
Mailing Address - Fax:
Practice Address - Street 1:2558 KENDALL RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-1141
Practice Address - Country:US
Practice Address - Phone:216-287-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4812103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst