Provider Demographics
NPI:1518446673
Name:ROSALES GUERRA, MAYRA M (BCBA)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:M
Last Name:ROSALES GUERRA
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 1:1431 SILVERGATE WAY
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6101
Mailing Address - Country:US
Mailing Address - Phone:470-561-0340
Mailing Address - Fax:
Practice Address - Street 1:1431 SILVERGATE WAY
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-6101
Practice Address - Country:US
Practice Address - Phone:470-561-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GA1-21-48802103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician