Provider Demographics
NPI:1770110405
Name:CIACCIA, AUTUMN MICHELE (BCBA)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:MICHELE
Last Name:CIACCIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:MICHELE
Other - Last Name:TROYANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:123 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-3118
Mailing Address - Country:US
Mailing Address - Phone:215-771-4178
Mailing Address - Fax:
Practice Address - Street 1:123 WILLOW DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-3118
Practice Address - Country:US
Practice Address - Phone:215-771-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-1939893103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst