Provider Demographics
NPI:1689070815
Name:SIAL, ALIZA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:SIAL
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 1:26 ALLSTON ST
Mailing Address - Street 2:APT 11
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2469
Mailing Address - Country:US
Mailing Address - Phone:202-250-4183
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST
Practice Address - Street 2:SUITE G30
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:202-250-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11314650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst