Provider Demographics
NPI:1144830944
Name:GERALD PUCILLO APPLIED BEHAVIOR ANALYST, P.C.
Entity type:Organization
Organization Name:GERALD PUCILLO APPLIED BEHAVIOR ANALYST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUCILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, BCBA, LBA
Authorized Official - Phone:716-316-5069
Mailing Address - Street 1:875 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1426
Mailing Address - Country:US
Mailing Address - Phone:716-316-5069
Mailing Address - Fax:
Practice Address - Street 1:875 PAGE AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1426
Practice Address - Country:US
Practice Address - Phone:716-316-5069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty