Provider Demographics
NPI:1588172126
Name:SRIVATS, SIERRA ROSE
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:ROSE
Last Name:SRIVATS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21241 VENTURA BLVD STE 187
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2196
Mailing Address - Country:US
Mailing Address - Phone:818-203-5063
Mailing Address - Fax:
Practice Address - Street 1:21241 VENTURA BLVD STE 187
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2196
Practice Address - Country:US
Practice Address - Phone:818-203-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1833106S00000X
CA1-22-58164103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician