Provider Demographics
NPI:1477191526
Name:SCIACCA, ANGELA THERESA (BCBA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:THERESA
Last Name:SCIACCA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:THERESA
Other - Last Name:SCIACCA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:22 W WASHINGTON ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1607
Mailing Address - Country:US
Mailing Address - Phone:708-912-1903
Mailing Address - Fax:
Practice Address - Street 1:22 W WASHINGTON ST STE 1500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1607
Practice Address - Country:US
Practice Address - Phone:708-912-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-24-73610103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst