Provider Demographics
NPI:1154954337
Name:PERILO, NATALI (BCBA, LBA-NY)
Entity type:Individual
Prefix:
First Name:NATALI
Middle Name:
Last Name:PERILO
Suffix:
Gender:F
Credentials:BCBA, LBA-NY
Other - Prefix:
Other - First Name:NATALI
Other - Middle Name:
Other - Last Name:WACHTMAN PERILO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:811 CORTELYOU RD APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5298
Mailing Address - Country:US
Mailing Address - Phone:917-602-4764
Mailing Address - Fax:
Practice Address - Street 1:811 CORTELYOU RD APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5298
Practice Address - Country:US
Practice Address - Phone:917-602-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00082101103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst