Provider Demographics
NPI:1134685936
Name:SIRRI, NATILY
Entity Type:Individual
Prefix:
First Name:NATILY
Middle Name:
Last Name:SIRRI
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 1:11045 CAMARILLO ST APT 108
Mailing Address - Street 2:
Mailing Address - City:W TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1297
Mailing Address - Country:US
Mailing Address - Phone:818-331-0728
Mailing Address - Fax:
Practice Address - Street 1:11045 CAMARILLO ST APT 108
Practice Address - Street 2:
Practice Address - City:W TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-1297
Practice Address - Country:US
Practice Address - Phone:818-331-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 106S00000X
CA132954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician