Provider Demographics
NPI:1154601649
Name:TORCIVIA, PENNY L (BCBA)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:L
Last Name:TORCIVIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9685
Mailing Address - Country:US
Mailing Address - Phone:610-759-5064
Mailing Address - Fax:
Practice Address - Street 1:4520 GRAYSTONE DR
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9685
Practice Address - Country:US
Practice Address - Phone:610-759-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-11-8268103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst