Provider Demographics
NPI:1366720575
Name:TSILEVICH, OLGA M (MA, BCBA)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:M
Last Name:TSILEVICH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BELLEZZA TER
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4315
Mailing Address - Country:US
Mailing Address - Phone:917-589-8089
Mailing Address - Fax:561-792-8756
Practice Address - Street 1:129 BELLEZZA TER
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4315
Practice Address - Country:US
Practice Address - Phone:917-589-8089
Practice Address - Fax:561-792-8756
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-8053103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-11-8053OtherBOARD CERTIFIED BEHAVIOR ANALYST