Provider Demographics
NPI:1316480668
Name:DE LA GARZA, ELIZABETH MARIE (MED BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:DE LA GARZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED BCBA
Mailing Address - Street 1:3028 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4129
Mailing Address - Country:US
Mailing Address - Phone:415-770-9443
Mailing Address - Fax:
Practice Address - Street 1:3028 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4129
Practice Address - Country:US
Practice Address - Phone:415-770-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-15-02549106S00000X
CA1-19-36045103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician