Individual
CEDRIC CRISOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., BCBA
Contact information
Practice address
17609 VENTURA BLVD, ST. 215, ENCINO, CA 91316-3858
(818) 501-8352
(818) 501-8325
Mailing address
17609 VENTURA BLVD, ST. 215, ENCINO, CA 91316
(818) 414-9211
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11314656
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7068
—
CA
05
—
7420
—
CA
Enumeration date
09/09/2009
Last updated
11/22/2013
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