Cedric Crisolo, M.A., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

11314656 Issued in CA

Practice address

17609 Ventura Blvd
St. 215
Encino, CA 91316-3858

Phone

(818) 501-8352

Fax

(818) 501-8325

NPI assigned

Sep 9, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385078400000",
    "number": "1053644013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17609 VENTURA BLVD",
            "address_2": "ST. 215",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "91316",
            "telephone_number": "818-414-9211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17609 VENTURA BLVD",
            "address_2": "ST. 215",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913163858",
            "telephone_number": "818-501-8352",
            "fax_number": "818-501-8325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISOLO",
        "first_name": "CEDRIC",
        "credential": "M.A., BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-09",
        "last_updated": "2013-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "11314656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7068",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gary Arthur Crouppen, PH.D.

• Behavior Analyst in Encino, CA
• Providers in Encino, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.