Provider Demographics
NPI:1801124243
Name:TROTTA, MICHAEL A (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:TROTTA
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:TROTTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:56 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175-5100
Mailing Address - Country:US
Mailing Address - Phone:270-501-0858
Mailing Address - Fax:270-828-5801
Practice Address - Street 1:56 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175-5100
Practice Address - Country:US
Practice Address - Phone:270-501-0858
Practice Address - Fax:270-828-5801
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-5557103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst