Provider Demographics
NPI:1598230336
Name:SIERRA, KORAIMA (BCBA, LBA-AZ)
Entity Type:Individual
Prefix:
First Name:KORAIMA
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:BCBA, LBA-AZ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2650
Mailing Address - Country:US
Mailing Address - Phone:520-484-1010
Mailing Address - Fax:
Practice Address - Street 1:2285 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2650
Practice Address - Country:US
Practice Address - Phone:520-484-1010
Practice Address - Fax:602-926-0352
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0-21-12054106E00000X
106S00000X
AZBEH000928103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician