Provider Demographics
NPI:1326856980
Name:VIEIRA, MARIANITA CARBONARE (BCBA)
Entity type:Individual
Prefix:
First Name:MARIANITA
Middle Name:CARBONARE
Last Name:VIEIRA
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 1:18 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3827
Mailing Address - Country:US
Mailing Address - Phone:707-624-9747
Mailing Address - Fax:
Practice Address - Street 1:3272 SONOMA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2918
Practice Address - Country:US
Practice Address - Phone:707-332-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB526047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst