Provider Demographics
NPI:1093385601
Name:SANCHEZ, MARISA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:SANCHEZ
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 1:152 CASTLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4027
Mailing Address - Country:US
Mailing Address - Phone:312-497-9305
Mailing Address - Fax:
Practice Address - Street 1:152 CASTLEWOOD CT
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4027
Practice Address - Country:US
Practice Address - Phone:312-497-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-22-60315103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician