Provider Demographics
NPI:1497399950
Name:GUZMAN, NICOLAS (BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:GUZMAN
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 1:17842 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3317
Mailing Address - Country:US
Mailing Address - Phone:650-740-1801
Mailing Address - Fax:818-748-1772
Practice Address - Street 1:17842 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3317
Practice Address - Country:US
Practice Address - Phone:650-740-1801
Practice Address - Fax:818-748-1772
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-20-41563103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician