Provider Demographics
NPI:1477095610
Name:GORGIE, SEAN (BCBA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:GORGIE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 MARTIN STE 170
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1450
Mailing Address - Country:US
Mailing Address - Phone:949-474-5577
Mailing Address - Fax:
Practice Address - Street 1:1520 E OCEANFRONT
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92661-1414
Practice Address - Country:US
Practice Address - Phone:714-454-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-23878103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst