Provider Demographics
NPI:1194066787
Name:ALVARADO, MARILYN (BCBA)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:ALVARADO
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 1:15720 VENTURA BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2997
Mailing Address - Country:US
Mailing Address - Phone:818-728-9370
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 403
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2997
Practice Address - Country:US
Practice Address - Phone:818-728-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9703103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst