Provider Demographics
NPI:1528478013
Name:IACOVIELLO, KENNETH ANGELO (MS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ANGELO
Last Name:IACOVIELLO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W TROPICANA AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4604
Mailing Address - Country:US
Mailing Address - Phone:917-445-7187
Mailing Address - Fax:
Practice Address - Street 1:6130 W TROPICANA AVE STE 145
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4604
Practice Address - Country:US
Practice Address - Phone:702-900-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-18-66777106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician