Provider Demographics
NPI:1790029718
Name:VERA, REYES W (BCBA)
Entity Type:Individual
Prefix:
First Name:REYES
Middle Name:W
Last Name:VERA
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 1:1325 ROLAND HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1211
Mailing Address - Country:US
Mailing Address - Phone:443-717-0510
Mailing Address - Fax:443-869-2293
Practice Address - Street 1:1325 ROLAND HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1211
Practice Address - Country:US
Practice Address - Phone:443-717-0510
Practice Address - Fax:443-869-2293
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9636103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst