Provider Demographics
NPI:1396234647
Name:NOVIELLO, LEA MICHELLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:MICHELLE
Last Name:NOVIELLO
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 1:136 TRADEWIND RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16102-2705
Mailing Address - Country:US
Mailing Address - Phone:724-944-3620
Mailing Address - Fax:
Practice Address - Street 1:8170 SOUTH AVE STE 7
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6434
Practice Address - Country:US
Practice Address - Phone:724-944-3620
Practice Address - Fax:724-965-1475
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-22-58964103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty