Provider Demographics
NPI:1861937641
Name:MANCIL, SUZANNE NORA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:NORA
Last Name:MANCIL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:NORA
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 SIERRA BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:TULAROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88352
Mailing Address - Country:US
Mailing Address - Phone:575-415-5220
Mailing Address - Fax:
Practice Address - Street 1:117 SIERRA BLANCA AVE
Practice Address - Street 2:
Practice Address - City:TULAROSA
Practice Address - State:NM
Practice Address - Zip Code:88352
Practice Address - Country:US
Practice Address - Phone:575-415-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22314103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst