Provider Demographics
NPI:1568830438
Name:SAGHERIAN, MICHAEL (BCBA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SAGHERIAN
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 1:4343 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1206
Mailing Address - Country:US
Mailing Address - Phone:860-748-3626
Mailing Address - Fax:
Practice Address - Street 1:215 W FRANKLIN ST STE 305
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2714
Practice Address - Country:US
Practice Address - Phone:831-901-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-45013103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst