Provider Demographics
NPI:1275900631
Name:SIERRA, MARIAH (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:SIERRA
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 1:605 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9328
Mailing Address - Country:US
Mailing Address - Phone:575-219-0039
Mailing Address - Fax:
Practice Address - Street 1:605 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9328
Practice Address - Country:US
Practice Address - Phone:575-219-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0-17-7735106E00000X
NM0-22-48264103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst