Provider Demographics
NPI:1306228770
Name:RANIELLO, THERESA ANNE
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANNE
Last Name:RANIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:ANNE
Other - Last Name:RANIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1574 N JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1210
Mailing Address - Country:US
Mailing Address - Phone:631-873-6311
Mailing Address - Fax:
Practice Address - Street 1:1574 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1210
Practice Address - Country:US
Practice Address - Phone:631-873-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11417067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst