Provider Demographics
NPI:1407199268
Name:VERA, CYNTHIA LOPEZ (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOPEZ
Last Name:VERA
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 45TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2309
Mailing Address - Country:US
Mailing Address - Phone:206-465-5276
Mailing Address - Fax:
Practice Address - Street 1:5019 45TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2309
Practice Address - Country:US
Practice Address - Phone:206-465-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-11772103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst