Provider Demographics
NPI:1790394807
Name:MODEL, MARICRIS CUDAL (BCBA)
Entity Type:Individual
Prefix:
First Name:MARICRIS
Middle Name:CUDAL
Last Name:MODEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARICRIS
Other - Middle Name:NICANOR
Other - Last Name:CUDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:543B NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5814
Mailing Address - Country:US
Mailing Address - Phone:415-533-4788
Mailing Address - Fax:
Practice Address - Street 1:150 SUTTER ST UNIT 120
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-9004
Practice Address - Country:US
Practice Address - Phone:415-989-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-37030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst