Provider Demographics
NPI:1841011020
Name:VITTORIO, SAMANTHA DEAN (BCBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DEAN
Last Name:VITTORIO
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 BEAM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3404
Mailing Address - Country:US
Mailing Address - Phone:812-900-5463
Mailing Address - Fax:855-919-4295
Practice Address - Street 1:2369 BEAM RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3404
Practice Address - Country:US
Practice Address - Phone:812-900-5463
Practice Address - Fax:855-919-4295
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-24-76682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst