Provider Demographics
NPI:1124449269
Name:HILLER-VASQUEZ, SHERRY (BCBA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:HILLER-VASQUEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W 190TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4925
Mailing Address - Country:US
Mailing Address - Phone:310-819-4523
Mailing Address - Fax:877-394-6799
Practice Address - Street 1:1515 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4319
Practice Address - Country:US
Practice Address - Phone:310-819-4523
Practice Address - Fax:877-394-6799
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-12863103K00000X
CALMFT107867106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist