Active NPI
Vanessa Petrillo, BCBA
- Behavior Analyst
- Roanoke Rapids, NC
National Provider Identifier
1548892102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 0133001014
- Practice address
- 212 Olde Chimney Rd
Roanoke Rapids, NC 27870-7529 - Phone
- (772) 359-8738
- NPI assigned
- Feb 11, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | LPA00147 | RI | |
| Behavior Analyst | 103K00000X | 0133001014 | VA | Primary |
Addresses
Primary practice location
212 Olde Chimney Rd
Roanoke Rapids, NC 27870-7529
Mailing address
212 Olde Chimney Rd
Roanoke Rapids, NC 27870-7529
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPA00147 | RI | MD | Behavioral Analyst |
| 0133001014 | VA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706313600000",
"number": "1548892102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 OLDE CHIMNEY RD",
"city": "ROANOKE RAPIDS",
"state": "NC",
"postal_code": "278707529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 OLDE CHIMNEY RD",
"city": "ROANOKE RAPIDS",
"state": "NC",
"postal_code": "278707529",
"telephone_number": "772-359-8738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRILLO",
"first_name": "VANESSA",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-11",
"last_updated": "2024-01-27",
"certification_date": "2024-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "RI",
"license": "LPA00147",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "VA",
"license": "0133001014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke Rapids, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.