Provider Demographics
NPI:1295959443
Name:AIELLO, STEPHANY CRISOLO (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANY
Middle Name:CRISOLO
Last Name:AIELLO
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:MRS
Other - First Name:STEPHANY
Other - Middle Name:SUPNET
Other - Last Name:CRISOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:2075 SILENCE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-1919
Mailing Address - Country:US
Mailing Address - Phone:408-821-6673
Mailing Address - Fax:
Practice Address - Street 1:1401 PARKMOOR AVE
Practice Address - Street 2:STE #208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3403
Practice Address - Country:US
Practice Address - Phone:925-989-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18780103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst