Provider Demographics
NPI:1154634962
Name:LAVARIAS, GERALD BICERA (BCBA)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:BICERA
Last Name:LAVARIAS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:BICERA
Other - Last Name:LAVARIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:5500 MING AVE
Mailing Address - Street 2:SUITE # 228
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309
Mailing Address - Country:US
Mailing Address - Phone:661-397-4777
Mailing Address - Fax:661-397-4277
Practice Address - Street 1:5500 MING AVE
Practice Address - Street 2:SUITE # 228
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-397-4777
Practice Address - Fax:661-397-4277
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7159103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst